Lebogang Mmelesi
Team Leader - Medical Payments
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.
Team Leader experienced in directing activities of workgroups, developing strategies, provides training, sets goals and obtains team feedback. Excellent interpersonal and communication skills. Big picture focus with excellence in communicating goals and vision to succeed. Problem solver, networker, and consensus builder, who is organized and strict on building positive rapport, inspire trust and guide teams toward achievement of organizational goals. Strong facilitator adept at working cross-departmentally with co-management and top-level leadership. Excellent trainer and mentor.
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
13
13
years of professional experience
Work History
Team Leader - Medical Payments
Rand Mutual Assurance
01.2022 - Current
- Full compliance always on team deliverables.
- Ensure that daily statistical reports are accurate.
- Accurate and timeous monthly reporting.
- Apply knowledge and correct application of different tariff schedules.
- Approve and authorize HCP demographics.
- Ensure high standard of client relationship - by means of attitude and knowledge(performance measured in terms of company survey)
- Continuous assessment and analysis of the processes and procedures with the goal of continuously improving efficiency and effectiveness.
- Managing the process of all production queries from other departments as well as the contact centre.
- Managing the team in alignment with the RMA way (Values,policy and procedures.)
- Adhoc responsibilities within agreed timelines and quality standards.
- Set performance expectations for the team, monitoring progress towards goals and providing constructive feedback as needed.
- Developed team members skills through targeted coaching sessions, resulting in improved individual performance.
- Enhanced team productivity by implementing efficient work processes and regularly reviewing performance metrics.
- Mentored junior staff members, helping them develop their leadership potential and advance in their careers.
Medical Invoice Controller
Rand Mutual Assurance
1 2017 - 12.2021
- 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 Business Analysis -
Faculty Training Institute
04.2001 -
Advanced Diploma in Management Practice -
Henley Business School
BCompt in Management Accounting - undefined
University of South Africa
Bachelor of Technology in General Management - undefined
Tshwane University of Technology
Diploma in General Management - undefined
Tshwane University of Technology
High School Diploma - undefined
Hoerskool Hartbeesport
Skills
Interpersonal Skills
Processing payments
Negotiation
Staff Management
Strategic Planning
Team Oversight
Reliability
Problem-solving abilities
Teamwork and Collaboration
Adaptability
References
- Akhona Ntanjana, Manager MIA (RMA), 010 214 3094/073 397 6333
- Humbulani Mmusi, Customer Service Team Leader (RMA), 010 214 3085/084 812 6271
- Noluthando Nkosi, Marketing Coordinator (South Point), 072 426 7201/082 905 0229
- Nombulelo Chiloane, Deputy Director (UIF), 012 337 1508/082 885 1318
Timeline
Team Leader - Medical Payments
Rand Mutual Assurance
01.2022 - 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 Business Analysis -
Faculty Training Institute
04.2001 -
Medical Invoice Controller
Rand Mutual Assurance
1 2017 - 12.2021
Advanced Diploma in Management Practice -
Henley Business School
BCompt in Management Accounting - undefined
University of South Africa
Bachelor of Technology in General Management - undefined
Tshwane University of Technology
Diploma in General Management - undefined
Tshwane University of Technology
High School Diploma - undefined
Hoerskool Hartbeesport
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