Hospital Tariffs and Billing Specialist at GEMS

About the position

Introduction

Internal Job Title - Hospital Tariffs and Billing Rules Specialist

The position of Hospital Tariffs and Billing Rules Specialist is vacant. The Hospital Tariffs and Billing Rules will report directly to the Manager: Hospital Tariffs and Billing Rules and forms part of the Healthcare Management Division. The position is based at Head Office in Pretoria.

The remuneration package for this position is R 1 136 890 per annum based on qualifications and experience.

The closing date for applications will be Thursday, 05 February 2026.

Duties & Responsibilities

The Hospital Tariffs and Billing Rules Specialist will be required to provide support to the Manager: Hospital Tariffs and Billing Rules through the implementation of the following Key Performance Areas (KPAs):

• Work closely with the Tariff File Coordinator, Coding, and Clinical Managers to deliver high-quality work.
• Support the Scheme funding decisions through technical review, application, and validation of any changes to the GEMS Master Tariff and Billing Rules Files based on best practice standards.
• Work closely with the Clinical Team to ensure that the GEMS Master Tariff and Billing Rules Files are in accordance with evidence-based medicine and industry dynamics.
• Ensure that Service Provider Networks (SPNs) apply the GEMS Master Tariff and billing Rules Files according to GEMS requirements.
• Evaluate GEMS Master Tariff and billing Rules Files appropriateness and inefficiencies and recommend corrective action.
• Assists in monitoring and managing SPNs' SLA compliance.
• Identify, assess and mitigate risk.

Desired Experience & Qualification

Qualification requirements are:

• Diploma or NQF level 6 qualification.
• Minimum of 3-5 years functional experience.
• Proven experience in tariff coding and billing rules; managed care and/or medical schemes. administration; claims assessing and processing and data handling.
• Team Leader in tariff coding and claims management environment.
• Experience in Stakeholder engagement.
• A good understanding of ICD10, CPT 4, NAPPI and tariff coding.
• Excellent knowledge of NHRPL coding.
• A good understanding of the Medical Schemes Act.
• Strong analytical and administrative skills.
• Strong verbal and written communication and interpersonal skills.
• Good organisational ability and ability to meet tight deadlines.
• Critical thinking skills and the ability to work independently under pressure and as part of a team.
• Quality check and quality assurance skills.
• Must be able to work in a team.
• High-level initiative as a self-starter, reliable and proactive.
• Have resilient pressure management skills.
• Report writing and presentation skills.
• Intermediate to Advanced MS Office skills.
• Sound planning / project management skills.
• Have a diligent work ethic with attention to detail.
• Must be in a position of a driver's license with own vehicle and be willing to travel on short notice.
• Organised and have good time management skills.
• Customer service skills.
• Data analysis skills.

Interested?

The closing date for applications is 01 April 2025. Should you not hear from us by 30 April 2025, please consider your application unsuccessful.

GEMS employs people with the highest level of integrity - submission to the appropriate pre-employment assessment is obligatory to be considered for the position.

Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.

Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need, or permission is granted from the applicant themselves to make use of it for other purpose.

Should you wish to have your information removed from the GEMS database, kindly send a request in writing to [Email Address Removed] .

GEMS adopts a hybrid work model.

GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.

Successful candidates will be required to seek approval to conduct other work outside of GEMS.

GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration.