Director: Provider Payment Mechanism And Rates

Requirements

Grade 12 certificate and an undergraduate qualification (NQF level 7) as recognized by SAQA in Finance/Accounting, Cost Accounting, Economics, Health Economics, or Actuarial Sciences. A postgraduate qualification (NQF level 8) in relevant disciplines such as Finance and Accounting, Cost Accounting, Health Economics, Actuarial Sciences or a related quantitative social sciences field would be an advantage. At least five (5) years’ experience at a middle/senior managerial level in Health Economics/ Accounting within the health sector. Experience in conducting sophisticated quantitative analyses and proven economic research output relating to health economic modelling techniques as well as experience in developing health-focused econometric models using decision analysis software. Expert knowledge of Excel and VBA (Visual Basic for Applications) experience. Intimate knowledge of health benefit design and payment, and National Health Insurance. Knowledge of CPT coding, ICD-10 and other international coding systems and understanding of medical terminology. Knowledge of other programs such as Python, R, and SQL will be an added advantage. Knowledge and understanding of Public Service Regulation, Public Service Act, Public Finance Management Act and National Health Insurance (including provisions of the NHI Act) Good communication (verbal and written), problem solving, organizational, decision making, interpersonal, assertiveness, planning, customer service, team management and computer skills (MS Office packages). Self-motivated and ability to work independently. A valid driver’s license. SMS pre-entry Certificate is required for appointment finalization.

Key Responsibilities

Review the existing data collection and reporting process in health care facilities; the flow of funds; identify changes needed to move from input-based payment to prospective payment (e.g. Capitation and Diagnosis Related Groupers). Develop an approach to on-going revisions of provider payment systems, and develop proof-of-concept, and progressively implement new provider payment mechanisms. Determine the nature of provider payment mechanisms and adopt additional mechanisms, including capitation for PHC and DRG for hospitals. Define cost modelling methodology and required data sets and develop costing manual and determine the prices of health care services/drugs/consumables to be paid by the NHI Fund based on developed costing manual. Prepare information and communicate to the public (users, providers and other stakeholders) on the prices of services/drugs/consumables included in the Health Care Benefits to be covered by the NHI Fund. 75

How to Apply

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