Risk Controller

Last updated: 1 day ago

Job Description
We're looking for… Are you an experienced Medical Billing & Collections Administrator looking for a role where your attention to detail and organizational skills make a real impact?

Join our clients' healthcare team and play a vital role in ensuring the smooth processing of patient claims and payments.

If you have a strong background in medical funder interactions, claims processing, and collections, we'd love to hear from you!

Who are you?

• You have strong attention to detail and accuracy in data entry.
• You have excellent communication skills to liaise with funders, patients, and internal teams.
• You have strong organizational and reporting skills.

What's the role?

You will be responsible for:

1. Medical Billing & Claims Processing:
   Review and process weekly hospital stats for billing accuracy.
   Capture patient details and treatment codes into the system.
   Submit and track claims via the in-house system.
   Investigate and resolve claim rejections—resubmit where necessary.
   Follow up on remittance advice and liaise with funders on rejected claims.
   Ensure all necessary information is included for claim approvals.
2. Collections & Payments:
   Generate and analyse age analysis reports weekly.
   Maintain a summary spreadsheet to track outstanding accounts.
   Follow up with funders, government institutions, or patients regarding outstanding payments.
   Request and verify Proof of Payment (POP) from payers.
   Reconcile received payments with system records and update accordingly.
   Provide weekly reports on collections, expected payments, and outstanding debts.
   Maintain proactive communication with funders to keep accounts up to date.

Requirements
Boxes to tick…
Matric
2+ years experience in the relevant field
Experience in medical billing, claims processing, or collections.
Familiarity with Solumed or similar medical billing software.
Ability to handle funding queries and resolve claim disputes.