Pricing and Reimbursement Specialist

SUMMARY:
Our client in the medical healthcare industry is currently looking for a highly organised Pricing and Reimbursement Specialist that has an eye for detail that will manage all aspects of the pricing strategy. The candidate will be based in Ballito, Kwa-Dukuza

POSITION INFO:
Position: Pricing and Reimbursement Specialist

Location: Ballito, Kwa-Dukuza

Reports To: Financial Manager


Job Summary:

We are seeking a highly organized and detail-oriented Pricing and Reimbursement Specialist to manage all aspects of pricing strategy and execution across both private and public (state) healthcare sectors. This individual will be responsible for submitting product and service pricing applications to medical insurance companies, ensuring timely price increase submissions, and managing billing and reimbursement processes with insurers.

Minimum Qualifying Criteria:

• 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.

• 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.

• 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.

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