Pricing and Reimbursement Specialist

SUMMARY:
Ballito - A leading medical device supplier in South Africa is seeking a highly organized and detail-focused individual to take on the role of Pricing and Reimbursement Specialist.
This role involves overseeing pricing strategies and implementation for both the private and public healthcare sectors.

POSITION INFO:
Key responsibilities include preparing and submitting pricing applications to medical aid schemes, managing timely price adjustments, and handling billing and reimbursement processes with insurers.

Key Responsibilities:
Pricing Strategy and Management:

• Develop and maintain together with management competitive and compliant pricing structures across both sectors.
• Coordinate and submit timely applications for price increases, ensuring adherence to all relevant deadlines and policies.
• Analyze market trends, competitor pricing, and regulatory updates to inform pricing strategies.

• Prepare and submit product and service pricing applications to medical health insurance companies.
• Track and manage the approval process, ensuring accurate and complete documentation.
• Act as a point of contact for insurer inquiries regarding applications.

• Prepare and submit accurate invoices to medical health insurers for services rendered.
• Monitor claim status, follow up on delayed or disputed payments, and resolve issues promptly.
• Ensure all billing complies with insurer guidelines and contract terms.

• Maintain accurate records of all pricing, application, and billing activities.
• Ensure compliance with local healthcare regulations, pricing policies, and insurer requirements.
• Generate reports on pricing performance, approval timelines, and billing efficiency for internal stakeholders.

• Bachelor’s degree in Business, Health Economics, Finance, Nursing or a related field.
• Minimum of 3–5 years’ experience in pricing, reimbursement, or healthcare billing.
• Strong understanding of private and state healthcare systems, particularly regarding reimbursement.
• Proficiency in Microsoft Excel and billing software; ERP/CRM experience is an advantage.
• Excellent written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Excellent attention to detail.
• Ability to manage multiple priorities and deadlines.
• Proactive and self-motivated approach.
• Strong interpersonal and negotiation skills.