Role Description
The Funder Relations and Contracting Manager is responsible responsible for the strategic management, implementation, and optimisation of all medical scheme, funder, and insurance agreements across Intercare Care Settings to ensure compliant billing, accurate tariff application, system integrity, and sustainable revenue growth.
CRITICAL OUTPUTS
Maintain expert knowledge of all medical scheme, funder, and insurance network agreements applicable to Intercare Care Settings.
Evaluate and recommend network participation aligned to patient demographics, clinical scope, fee structures, and growth strategy.
Ensure all funder and network agreements are correctly implemented, governed, and adhered to across Care Settings.
Act as the primary escalation point for contractual, tariff, billing, and compliance-related matters with funders and insurers.
Monitor and evaluate the financial feasibility, profitability, and growth impact of network participation and contractual decisions.
Obtain, maintain, and ensure accurate configuration of all tariffs on systems to support compliant and optimal billing.
Identify incorrect tariff applications, implement corrective actions, and manage tariff changes timeously.
Champion compliant coding and billing aligned to NRPL, SAMA, SADA, and funder-specific rules and agreements.
Analyse monthly coding and billing reports to identify missed revenue opportunities, non-compliance, and over-servicing risks.
Support practices during forensic audits and proactively mitigate financial, regulatory, and compliance risks.
Develop, maintain, and deliver coding, billing, tariff, and funder training and guidelines for clinical, administrative, and finance teams.
Build and maintain strong working relationships with funders, insurers, Care Settings, and internal stakeholders to support negotiation, dispute resolution, and sustainable revenue optimisation.
Role Requirements
Relevant qualification at NQF Level 7 is required; NQF Level 8 will be advantageous.
Minimum of 5 years' experience in healthcare contracting, funder relations, or commercial healthcare roles.
At least 2 years' experience in a leadership or people management role.
Preference for 7 years' experience within a hospital group or large healthcare organisation.
Proven exposure to high-value negotiations, complex stakeholder environments, and healthcare funding models.
Advanced knowledge of medical scheme regulations, ICD-10, CPT coding, and private healthcare payment structures.
Deadline:29th January,2026