Summary
Overview
Work History
Education
Skills
References
Timeline
Generic
Lebogang Mmelesi

Lebogang Mmelesi

Medical Invoice Controller
Roodepoort

Summary

I am confident that I can contribute significantly to this position, you will find someone who is unusually dedicated, self-motivated, and ambitious, who possesses the detail-orientation and technical skills to excel in a fast-paced environment.


Apart from the day-to-day activities of medical payments I act as the assistant team leader. I Ensure that all invoices are captured within an average of 3 days from date of receipt,ensure that medical accounts are paid promptly and correctly, manage key accounts and provider queries,ensure clear display and communication of payment details, rejections and reasons for non-payment, ensure medical creditors are paid within reasonable time where all claim requirements are met,which requires Knowledge and correct application of different tariff schedules, I ensure that inactive providers are activated when the relevant information is received and that all queries are addressed with supporting business units within 24 hours. I Ensure that monthly statistical reports are accurate and provide supervision to the team.


I always strive to achieve the highest standard possible, at any given task and in any situation; I am tenacious in utilizing my expertise in COIDA and I have been pivotal in ensuring that business under my supervision is equipped with the necessary tools to meet aggressive targets and growth plans.

Overview

12
12
years of professional experience

Work History

Medical Invoice Controller

Rand Mutual Assurance
01.2017 - Current
  • Manage and review medical invoices where automated payment criteria are not met
  • Manage and process 250 invoices per day
  • Negotiate and agree discounts with all Medical Service Providers on high valued invoices
  • Educate Medical Service Providers (MSP) regarding RMA requirements in respect of submission of accounts on an ongoing basis
  • Monitor invoices for over servicing as well as identify incorrectly billed invoices
  • Assist Claims Processing Staff with understanding medical service appropriateness
  • Ensure medical creditors are paid within 10 days from date of receipt
  • Apply clinical rules and protocols on validation of invoices
  • Scrutinize medical invoices ensuring modifiers are applied on medical invoices
  • Communicate with external clients regarding reasons for suspended and rejected invoices
  • Manage and monitor medical payments to prevent wasteful expenditure
  • Monitor and provide technical support to medical service providers
  • Manage the administrative of medical tariffs
  • Manage and ensure financial management and compliance to COID tariffs
  • Develop and implement quality assurance system for clinical coding
  • Manage the coding program for the effective and timely coding of diagnoses and procedures for patient
  • Manage the administration of medical billing
  • Monitor compliance with medical billing procedures
  • Maintain medical billing codes on RMA system.

Medical Invoice Processor

Rand Mutual Assurance
01.2015 - 01.2017
  • Handling 200 invoices per day (includes capturing, duplicates & queries), Daily targets to be achieved daily
  • Accurate assessment of invoices prior to capturing according to set criteria and company business rules in respect of liability
  • Using the COIDA Tariffs and any other agreed Tariffs
  • Ensure all queries are resolved within 24 hours, report any delays to HOD
  • Knowledge and accurate application of different tariffs schedules: BHF, SAMA, COID, NRPL, ICD10 coding and Nappi Codes
  • Maximum of 5 reversals per month per user resulting out of duplicate payments, overpayments, incorrect payee and non-authorized procedures
  • Staff will not delete any invoices unless if the system delete it, unless instructed differently by the Team Leader
  • Attend to any queries that relate to incorrect processing of invoices or errors Ensure high standard of client relationship by means of attitude and knowledge.

UI Registration Officer

Unemployment Insurance Fund
01.2014 - 01.2015
  • Processing of new employer information
  • Maintaining information of existing employer records
  • Updating employment history of employees
  • Recording notices of liquidation and insolvency
  • Send emails and manual correspondence to employers
  • Conduct work study.

Resident Assistant

South Point Accommodation
01.2012 - 01.2014
  • Improvement of facilities in the student accommodation rooms
  • Office administration
  • Data collected done electronically
  • Manage groups of ambassadors for building
  • Manage the transportation of student to campuses
  • Improvement of facilities offered by Student Accommodation.

Education

Advanced Diploma in Management Practice -

Henley Business School
Sunninghill, South Africa
04.2001 -

BCompt in Management Accounting -

University of South Africa
Pretoria, South Africa
04.2001 -

Bachelor of Technology in General Management -

Tshwane University of Technology
Pretoria, South Africa
04.2001 -

Diploma in General Management -

Tshwane University of Technology
Pretoria, South Africa
04.2001 -

High School Diploma -

Hoerskool Hartbeesport
North West
04.2001 -

Skills

undefined

References

Warren Matthews - Manager MIA (RMA)

010 214 3359/082 552 2863


Akhona Ntanjana - Team Leader (RMA)

010 214 3094/073 397 6333


Noluthando Nkosi - Marketing Coordinator (South Point)

072 426 7201/082 905 0229


Nombulelo Chiloane - Deputy Director (UIF)

012 337 1508/082 885 1318


Timeline

Medical Invoice Controller

Rand Mutual Assurance
01.2017 - Current

Medical Invoice Processor

Rand Mutual Assurance
01.2015 - 01.2017

UI Registration Officer

Unemployment Insurance Fund
01.2014 - 01.2015

Resident Assistant

South Point Accommodation
01.2012 - 01.2014

Advanced Diploma in Management Practice -

Henley Business School
04.2001 -

BCompt in Management Accounting -

University of South Africa
04.2001 -

Bachelor of Technology in General Management -

Tshwane University of Technology
04.2001 -

Diploma in General Management -

Tshwane University of Technology
04.2001 -

High School Diploma -

Hoerskool Hartbeesport
04.2001 -

Similar Profiles

CREATE PROFILE
Lebogang MmelesiMedical Invoice Controller