Credit Control, Billing & Claims Administrator (Hospital)

SUMMARY:
An established healthcare facility in the Upper Highway area is seeking a detail-oriented Credit Control, Billing & Claims Administrator (Hospital). The successful candidate will manage accurate patient billing, medical scheme claims, and effective debtors control within a structured healthcare environment.

POSITION INFO:


Key Responsibilities

• Capture and verify patient billing information, including ICD-10 codes, tariff codes, and medical aid details
• Submit, track, and follow up on medical scheme and third-party claims
• Investigate and resubmit rejected or short-paid claims
• Manage pre-authorisations, benefit limits, and length-of-stay extensions
• Monitor and manage debtors age analysis (medical aids, patients, third-party payers)
• Follow up on outstanding accounts and manage co-payments and member liability balances
• Reconcile remittance advices and identify underpayments or discrepancies
• Maintain accurate billing, payment, and adjustment records
• Ensure compliance with medical scheme rules and patient confidentiality regulations
• Liaise with case managers, clinicians, finance teams, and scheme administrators

• Matric with Mathematics or Accounting
• Diploma or degree in Finance, Accounting, or related field advantageous
• 2–5 years’ experience in medical billing, claims administration, and credit control
• Must have experience in a hospital or inpatient healthcare setting 
• Working knowledge of ICD-10 coding, medical aid authorisations, and scheme rules
• Experience with medical billing systems (GoodX advantageous)
• Strong attention to detail, organisational skills, and ability to meet deadlines

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