Analyses of SAMA billing guide, RPL to develop and implement billing rules for all health care professionals within MMI • Ensure all rules related to ICD10, CPT4, DBM and RPL are automated in the rules engine thereby ensuring clinical auditing is conducted effectively and efficiently • Provide support to clinical auditors in regard to implementation of billing rules • Maintenance and update of the clinical rules engine and coding rules in relation to the claims software system pertaining to ICD 10, CPT4, SAMA DBM and RPL • Implementation of crosswalks in the claims, authorization, and data warehouse systems by providing IT and BI with clinical logic and rules • Development and implementation of policy, processes, standard operating procedures, and protocols to address clinical and financial risk • Development, implementation, monitoring and evaluation of clinical protocols • Implementation of coding crosswalks and underwriting risk tools through clinical knowledge and application of data analytical models to ensure accurate mappings. • Training of clinical auditing team regarding updates and implementation of billing rules • Proactive participation in client audits to verify outcomes of managed care health programs and rules • Interact with clients relating to queries pertaining to clinical rules, billing rules, managed care programs and reporting requirements • Provide progress reports within the work processes • Provide feedback to business regarding efficiencies of the DBM, RPL, ICD10 and CPT4 rules • Ensure that regular interaction and exchange of information is achieved between clinical coding and the business stakeholders. • Maintain and provide continual improvement of system functionality and development of effective solutions to issues identified Intermediate skill set in Microsoft Packages, MS Word, MS Excel and MS PowerPoint. Working knowledge of Medical Aid terminology and Coding systems. Knowledge of RPL, Nappi, CPT4 and ICD10 coding structures within the South African Medical industry. Coding work experience within a managed healthcare environment and medical claims experience. Fundamentals of Project management and Business Analysis. Technical support and systems testing.