Lerato Olga Seapei Rabuthu
Pretoria
Summary
Experienced with financial analysis, budgeting, and client consultation. Utilizes comprehensive accounting knowledge to optimize financial processes. Knowledge of industry regulations and best practices ensures accurate and compliant financial reporting. Professional in finance with a strong background in accounts management and client consultation. Proven track record in financial analysis, budgeting, and resolving client queries. Known for fostering team collaboration and adapting to changing needs while driving successful outcomes. Adept in using accounting software, financial reporting, and ensuring compliance with industry standards.
Overview
2025
2025
years of professional experience
Work History
Hospital Accounts Consultant
Universal Health Care
06.2019 - Current
- Company Overview: Medical
- Assist Hospital with unpaid accounts
- Deals with clients queries via telephone and email for short paid accounts
- Reconcile all Hospital accounts if the accounts are paid incorrectly as per billing rules
- Liaising with Hospitals on claim queries
- Ensure that more complex queries are escalated to the Case Managers for approval
- Check if the Hospital has journalized all the hospital bills that needs to be written off
- Prepare Reversals in short Paid accounts
- Medical
Consultant (Queries) (Corporate Scheme)
Medscheme (Afrocentric)
06.2017 - 05.2019
- Company Overview: Medical
- Timeous and reprocessing of claims
- Inform customers/providers regarding unclear/ incomplete invoices via appropriate methods (email and in writing/ telephonically)
- Answer phones and resolve member queries within determined SLA
- Transfer Member calls to appropriate staff, where necessary
- Identify, research, and resolve Member/provider issues using the computer system
- Follow-up on Member/provider enquires not immediately resolved, within determined SLA’s
- Complete call logs
- Follow and adhere to claim/contact center processes, procedures and protocol
- Recognize, document and alert the supervisor of trends with processing of claims
- Recommend process improvements
- Focus on first call resolution as far as possible
- Medical
- Evaluated client needs and expectations, establishing clear goals for each consulting engagement.
User Acceptance Testing Secondments
Medscheme (Afrocentric)
05.2016 - 05.2019
- Company Overview: Medical
- Create relevant test data for the execution of test cases
- Execute test cases and identify defects, log and track
- Document test results
- Escalate to Test Analyst when test results do not function as required
- Meet delivery objectives by working with other team members within and linked to the department/project
- Resolve operational performance variations and problems
- Escalate unresolved issues to higher levels
- Ensure delivery targets/objectives are met
- HP ALM Quality Centre
- Defect Management
- Medical
- Conducted end-to-end testing on applications before final release to ensure seamless functionality across all intended devices.
Claim Assessor – National Assessing VRG
Medscheme (Afrocentric)
May2021 - Jun2021
- Company Overview: Medical
- Receive and verify accounts if they are valid claims
- Verify that transactions comply with financial policies and procedures
- Prepare, verify, and process paper claims and EDI claims
- Data enter accounts for payment and also process them
- Process backup reports after data entry
- Record all accounts
- Maintain listing of accounts receivable and payable
- Medical
Claim Specialist (Clinical Audit Assistance) - Cla
Metropolitan Health
Nov2021 - May2021
- Company Overview: Medical
- Develop system to account for financial transactions by establishing a chart of accounts, defining bookkeeping policies and procedures
- Maintain subsidiary accounts by verifying, allocating, and posting transactions
- Balance subsidiary accounts by reconciling entries
- Maintain general ledger by transferring subsidiary account summaries
- Balance general ledger by preparing a trial balance; reconciling entries
- Maintain historical records by filing documents
- Prepare financial reports by collecting, analyzing, and summarizing account information and trends
- Comply with federal, state, and local legal requirements by studying requirements; enforcing adherence to requirements; filing reports; advising management on needed actions
- Contribute to team effort by accomplishing related results as needed
- Medical
- Reviewed and maintained accurate claim files, ensuring all necessary documentation was in place for future reference.
- Conducted thorough investigations into insurance claims to determine coverage eligibility and appropriate compensation amounts.
- Enhanced customer satisfaction with prompt and accurate claim resolutions, resulting in positive feedback and increased client retention.
Claim Assessor - Claims Department (Polmed Busines
Metropolitan Health
04.2012 - 10.2012
- Company Overview: Medical
- Perform the day-to-day processing of financial transactions to ensure that Service levels are met
- Receive and verify accounts if they are valid claims
- Verify that transactions comply with financial policies and procedures
- Prepare, verify, and process paper claims and coding payment documents for MVA claims
- Prepare batches of accounts for data entry
- Data enter accounts for payment and also process them
- Process backup reports after data entry
- Manage the weekly Claims run
- Record all accounts
- List all queries in the System for Referrals
- Maintain listing of accounts receivable and payable
- Maintain the general ledger
- Print and distribute monthly financial reports
- Medical
- Provided guidance to junior staff members on best practices for data collection and analysis, fostering a supportive and collaborative work environment.
- Improved property valuation accuracy by conducting thorough research and analysis of market trends, sales data, and local regulations.
- Achieved high levels of compliance through regular audits of exemption applications and adherence to established guidelines for qualification determination.
Call Centre Consultant - Metropolitan Health Group
Metropolitan Health
06.2011 - 03.2012
- Company Overview: Medical
- Confirm benefits for members
- Assist clients with unpaid accounts or claims
- Deal with clients queries via telephone in adherence with productivity standards
- Take inbound calls and shares relevant information
- Finalize call at point of contact where possible
- Ensure that more complex queries are escalated appropriately
- Assist walk in clients with queries
- Make outbound calls in accordance to the schedules
- Medical
- Evaluated client needs and expectations, establishing clear goals for each consulting engagement.
- Identified areas of improvement for clients'' operations, implementing targeted solutions to increase productivity.
- Increased client satisfaction by developing comprehensive consulting strategies tailored to each business's unique challenges and objectives.
Premium Management Clerk - Metropolitan Health Cor
Metropolitan Health
06.2010 - 05.2011
- Company Overview: Medical
- Registration of Dependents
- Maintain and update production control sheets daily
- File all documents relating to reconciliation process
- Ensure Persal invoice input are produced on time
- Prepare bank reconciliations accurate
- Assist other departments with problematic queries
- Reconcile contribution accurately accordingly
- Prepare and record the refund and arrear
- Facilitate payments
- Medical
Education
National Diploma - Internal Auditing
Tshwane University of Technology
Pretoria Diploma - Nursing and Patient Care
Alison Online Education
Pretoria11.2024
National High Certificate - Accountancy
Tshwane University of Technology
Pretoria12.2010
Matric -
Mamelodi High School
Pretoria12.2006
Skills
- Attention to detail
- Time Management
- Communication skills
- Computer skills
- Telephone etiquette
- Bank reconciliation
- Accounts receivable
- Accounts payable
- Accounting software proficiency
- Problem-solving
- Listening skills
- Problem-solving abilities
Languages
English
Setswana
Competenciesandskills
- Attention to detail and prioritising
- Time Management skills
- Communication skills (verbal and written)
- Computer skills
- Telephone etiquette
Knownas
Lerato
Personal Information
- Date of Birth: 02/21/88
- Nationality: South African
References
- Dinah Mkhize, Team Leader, Metropolitan health group, 0836565667
- Sammy Kopa, Team Leader, Afrocentric Health (Medscheme), 011 671 2000, 0648045539
- Isaac Nwedamutswu, Team Leader, Universal Health Care, 011 591 9890, 066 162 9889
Summary Of Experience
- Liaising with Hospitals and Members on claim queries.
- Working closely with Accounts Receivable department on Co-Payment feedback and pre auth department.
- Checking short paid accounts received by EDI and paper claim.
- Following up on the rejected reasons on the accounts and giving reasons for the short falls.
- In depth knowledge on ICD 10 Codes, EDI submissions and interpreting authorisation letters to execute billing correctly.
- Maintain productive, professional relationships with medical aids and members.
- Updating of incorrect member details on accounts.
- Giving feedback to management regarding outstanding medical payments.
- Keeping a good relationship with Hospital and Members.
- Reconcile transactions and balances to maintain accurate accounts.
- Doing consistent follow ups with members and hospital.
- Ensuring that the debtors ageing is managed in accordance with all hospital protocols, targets and objectives.
Timeline
Hospital Accounts Consultant
Universal Health Care
06.2019 - Current
Consultant (Queries) (Corporate Scheme)
Medscheme (Afrocentric)
06.2017 - 05.2019
User Acceptance Testing Secondments
Medscheme (Afrocentric)
05.2016 - 05.2019
Claim Assessor - Claims Department (Polmed Busines
Metropolitan Health
04.2012 - 10.2012
Call Centre Consultant - Metropolitan Health Group
Metropolitan Health
06.2011 - 03.2012
Premium Management Clerk - Metropolitan Health Cor
Metropolitan Health
06.2010 - 05.2011
Claim Assessor – National Assessing VRG
Medscheme (Afrocentric)
May2021 - Jun2021
Claim Specialist (Clinical Audit Assistance) - Cla
Metropolitan Health
Nov2021 - May2021
National Diploma - Internal Auditing
Tshwane University of Technology
Diploma - Nursing and Patient Care
Alison Online Education
National High Certificate - Accountancy
Tshwane University of Technology
Matric -
Mamelodi High School
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