Lerato Olga Seapei Rabuthu
Hospital Accounts Consultant
Pretoria
Summary
Results-driven healthcare billing and accounts professional with over 10 years of experience in medical aid claims, patient accounts, and financial reconciliation within hospital and healthcare environments. Adept at ensuring accurate billing, finalization of patient files, and adherence to tariff agreements and billing protocols. Skilled in communication, auditing, and system efficiency, with a proven record of optimizing revenue and resolving complex claim and account discrepancies.
Experienced account professional prepared for this role with strong track record of driving client satisfaction and delivering impactful solutions. Highly skilled in client relationship management, strategic planning, and financial analysis. Known for excellent collaboration and adaptability, ensuring seamless integration with team efforts and evolving project demands. Focused on achieving results and exceeding expectations in fast-paced environment.
Overview
15
15
years of professional experience
4
4
Languages
Work History
Hospital Accounts Consultant
Universal Health Care
06.2019 - Current
- Accurately bill hospital accounts and ensure complete patient documentation for final billing.
- Liaise with hospitals to resolve unpaid or short-paid accounts and reconcile transactions according to billing rules.
- Review and process complex account reversals and write-offs in line with organizational policies.
- Collaborate with case managers to address escalated claims and ensure prompt account finalization.
- Enhance revenue recovery through proactive follow-ups and accurate claim adjustments.
Claim Specialist
Metropolitan Health
05.2021 - 11.2021
- Verified, allocated, and posted healthcare transactions, ensuring compliance with financial policies.
- Reconciled accounts, maintained ledgers, and prepared reports to support billing and audit accuracy.
- Improved claim resolution turnaround time by identifying documentation gaps and ensuring adherence to billing protocols.
Claim Assessor
Medscheme
05.2021 - 06.2021
- Assessed and processed hospital and EDI claims, ensuring compliance with medical aid and billing regulations.
- Verified validity of claims and accurately captured data for prompt payment.
- Supported financial teams with account listings, reports, and reconciliation tasks.
User Acceptance Testing (UAT) Secondment
Medscheme (Afrocentric Health)
Roodepoort
05.2016 - 05.2019
- Created and executed test cases for billing systems and applications.
- Identified defects, documented test results, and ensured billing accuracy before system releases.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Passionate about learning and committed to continual improvement.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Demonstrated respect, friendliness and willingness to help wherever needed.
Claim Assessor / Call Centre Consultant / Premium Management Clerk
Metropolitan Health
Pretoria
06.2010 - 10.2012
- Processed MVA and hospital claims, verified financial transactions, and managed data entry for payments.
- Assisted members and providers with billing and account queries to improve satisfaction and retention.
- Achieved high levels of compliance through regular audits of exemption applications and adherence to established guidelines for qualification determination.
- Produced reports with detailed valuations.
- Ensured consistent application of state laws, policies, and procedures across all assessments by collaborating closely with fellow assessors.
Education
National Diploma - Internal Auditing
Tshwane University of Technology
Diploma - Nursing and Patient Care
Alison Online Education
National Higher Certificate - Accountancy
Tshwane University of Technology
Matric - undefined
Mamelodi High School
Skills
Billing accuracy & account reconciliation
ICD-10, EDI & DRG processes
Patient file management & documentation control
Medical aid tariffs & government gazette application
Revenue optimization & financial reporting
Hospital liaison & stakeholder communication
Microsoft Office & AS400 proficiency
Strong attention to detail & time management
References
- Dinah, Mkhize, Team Leader, 083 656 5667, Metropolitan Health
- Sammy, Kopa, Team Leader, 011 671 2000, 064 804 5539, Afrocentric Health (Medscheme)
- Isaac, Nwedamutswu, Team Leader, 011 591 9890, 066 162 9889, Universal Health Care
Timeline
Claim Specialist
Metropolitan Health
05.2021 - 11.2021
Claim Assessor
Medscheme
05.2021 - 06.2021
Hospital Accounts Consultant
Universal Health Care
06.2019 - Current
User Acceptance Testing (UAT) Secondment
Medscheme (Afrocentric Health)
05.2016 - 05.2019
Claim Assessor / Call Centre Consultant / Premium Management Clerk
Metropolitan Health
06.2010 - 10.2012
Diploma - Nursing and Patient Care
Alison Online Education
National Higher Certificate - Accountancy
Tshwane University of Technology
Matric - undefined
Mamelodi High School
National Diploma - Internal Auditing
Tshwane University of Technology