Medical Billing Claims Administrator - Pretoria East
Qetello Holdings
Medical Billing Claims Administrator
Location: Pretoria East, Gauteng
Position Type: Permanent | Full-Time
Salary: Market-Related (Based on Experience)
Industry: Medical Billing | Healthcare Administration | Specialist Medical Billing
About the Opportunity
Medical Resources Group is recruiting on behalf of our client, a well-established Medical Bureau based in Pretoria East, for an experienced and detail-oriented Medical Billing Claims Administrator.
This opportunity is ideally suited to a candidate with recent, hands-on experience in specialist medical billing who thrives in a fast-paced, process-driven environment. The successful candidate will have a strong understanding of private specialist billing, medical aid protocols, clinical coding, and claims management.
Key Responsibilities
Specialist Billing & Claims Administration
- Manage the full billing cycle for specialist medical clients.
- Submit medical aid claims and manage claim rejections and queries.
- Ensure accurate application of ICD-10, CPT, and procedure codes.
- Process PMB claims and apply relevant modifiers correctly.
- Maintain accurate and up-to-date billing records and patient information.
- Support month-end billing processes and account reconciliations.
Medical Aid & Client Liaison
- Liaise professionally with medical practices, patients, and medical schemes.
- Follow up on outstanding claims, rejections, and account queries.
- Ensure excellent client service and communication at all times.
- Maintain confidentiality and compliance with patient information regulations.
Administration & Reporting
- Ensure data integrity and accuracy of billing information.
- Maintain electronic filing and documentation systems.
- Assist with administrative functions relating to specialist billing and claims.
- Support internal processes and continuous improvement initiatives.
Minimum Requirements
Essential
- Matric / Grade 12.
- Minimum 2 years' recent medical billing experience within a Medical Bureau or Specialist Medical Practice.
- Direct billing experience for Medical Specialists.
- Strong working knowledge of:
- ICD-10 coding
- CPT and procedure coding
- Medical aid billing procedures and scheme rules
- PMBs and relevant modifiers
- Computer literate with proficiency in:
- Microsoft Excel
- Microsoft Outlook
- Medical Billing Systems
- Own reliable transport and a valid driver's licence.
- High attention to detail and data accuracy.
- Ability to work under pressure with minimal supervision.
- Excellent communication and client service skills.
Key Competencies
The ideal candidate will be:
- Detail-oriented and highly organised.
- Professional and client-focused.
- Accurate and process-driven.
- Able to manage multiple priorities and deadlines.
- Proactive and solution-driven.
- Able to work independently and as part of a team.
What Our Client Offers
- Competitive monthly salary based on experience.
- 21 days annual leave.
- Annual performance-based bonus.
- Exposure to specialist-focused billing and claims administration.
- Supportive and professional working environment.
- Long-term career growth opportunities.
How to Apply
Subject Line: Medical Billing Claims Administrator – Pretoria East
Please note: Only candidates with direct specialist medical billing experience will be considered.
If you do not receive feedback within 2 weeks, please consider your application unsuccessful.
