Mediclinic Cape Town | Cape Town | South Africa
Closing date: 10/01/2025
Number of positions: 1
Recruiter name: Helena Padayachee
Reference number: 56559
Workplace Type: On-site
Permanent
Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile.
MAIN PURPOSE OF JOB
To minimise financial risk by ensuring authorisation and re-authorisation of all cases through effective communication between relevant parties.
KEY RESPONSIBILITY AREAS
- Obtain authorisation and re-authorisation for all identified patients to ensure fully paid claims.
- Capture data and communicate to all parties.
- Identify and refer risk cases to minimise financial risks.
- Adhere to clinical coding standards as per Level 2 coding guideline.
- Ensure compliance to the confirmation procedure contracts and legal aspects by utilising available resources and systems.
REQUIRED EDUCATION
ESSENTIAL EDUCATION: Grade 12 or equivalent.
DESIRED EDUCATION: None.
REQUIRED EXPERIENCE
DESIRED EXPERIENCE: Experience in Clinical Environment.
REQUIRED JOB SKILLS AND KNOWLEDGE
- Funder Contracts; Medical aid requirements/narrations.
- Patient admin programmes on the AS400 system.
- Rules and regulations regarding funder contracts.
- Clinical coding (Level 2 coding).
- B2B EMS (electronic message system: check status of authorisations and use for troubleshooting).
- Relevant aspects of applicable statutory acts (e.g. Consumer Protection Act; PMB; etc.).
- Patient Administration policies and procedures (e.g. Patient Confidentiality; Visitation of external case managers; etc.).
- Daily workflow; managing deviances; coding; and case management processes.
- Identify possible financial risks (e.g. no authorisation; insufficient LOS or LOC; etc.).
All applicants will be considered, with the understanding that preference will be given in accordance with the Employment Equity Plan of Mediclinic Southern Africa, as well as internal applicants/employees that meet the minimum requirements.
Become a part of our Talent Community and we will get in touch with you as soon as there is a relevant opening that fits your skills, interests, and experience.
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