Pricing and Reimbursement Specialist

Position: Pricing and Reimbursement Specialist Location: Ballito, Kwa-Dukuza Reports To: Financial Manager Job Summary: We are seeking a highly organized and detail-oriented Pricing and Reimbursement Specialist to manage all aspects of pricing strategy and execution across both private and public (state) healthcare sectors. This individual will be responsible for submitting product and service pricing applications to medical insurance companies, ensuring timely price increase submissions, and managing billing and reimbursement processes with insurers. Minimum Qualifying Criteria: Bachelors Degree in Business, Health Economics, Finance, Nursing or a related field. Minimum of 35 years experience in pricing, reimbursement, or healthcare billing. Strong understanding of private and state healthcare systems, particularly regarding reimbursement. Proficiency in Microsoft Excel and billing software; ERP/CRM experience is an advantage. Excellent written and verbal communication skills. Roles and Responsibilities: Pricing Strategy and Management Develop and maintain together with management competitive and compliant pricing structures across both sectors. Coordinate and submit timely applications for price increases, ensuring adherence to all relevant deadlines and policies. Analyze market trends, competitor pricing, and regulatory updates to inform pricing strategies. Insurance Applications and Product Approval Prepare and submit product and service pricing applications to medical health insurance companies. Track and manage the approval process, ensuring accurate and complete documentation. Act as a point of contact for insurer inquiries regarding applications. Billing and Claims Management Prepare and submit accurate invoices to medical health insurers for services rendered. Monitor claim status, follow up on delayed or disputed payments, and resolve issues promptly. Ensure all billing complies with insurer guidelines and contract terms. Compliance and Reporting Maintain accurate records of all pricing, application, and billing activities. Ensure compliance with local healthcare regulations, pricing policies, and insurer requirements. Generate reports on pricing performance, approval timelines, and billing efficiency for internal stakeholders. Key Competencies Strong analytical and problem-solving skills. Excellent attention to detail. Ability to manage multiple priorities and deadlines. Proactive and self-motivated approach. Strong interpersonal and negotiation skills. How to Apply:

Location: Stanger, ZA

Posted Date: 5/30/2025