Confirmations Clerk

 

Job Title: Case Manager
Location: Mediclinic Medforum | Sunnyside, Pretoria, South Africa
Closing Date: 27/09/2024
Number of Positions: 1
Recruiter Name: Mokgadi Florah Hlungwani
Reference Number: 54244
Workplace Type: On-site
Employment Type: Permanent

Main Purpose of the Job

The primary objective of the Case Manager is to minimize financial risk for the hospital by ensuring proper authorisation and re-authorisation for all cases. This is achieved through effective communication between all relevant parties to secure fully paid claims.

Key Responsibility Areas

• Obtain initial authorisation and re-authorisation for patients to ensure payment.
• Capture and communicate data to relevant stakeholders effectively.
• Identify and escalate potential risk cases to minimize financial losses.
• Adhere to clinical coding standards according to Level 2 coding guidelines.
• Ensure compliance with contract confirmation procedures and legal regulations by utilizing hospital resources and systems efficiently.

Required Education

• Essential: Grade 12 or equivalent
• Desired: None

Required Experience

• Essential: None required
• Desired: Experience in a clinical environment would be advantageous

Required Job Skills and Knowledge

• Understanding of funder contracts and medical aid requirements.
• Familiarity with patient admin programs, particularly on the AS400 system.
• Knowledge of clinical coding (Level 2 coding) and funder contract regulations.
• Proficiency in B2B EMS (Electronic Message System) for checking authorisation statuses and troubleshooting.
• Proficient in Microsoft Office applications.
• Knowledge of relevant statutory acts (e.g., Consumer Protection Act, PMB).
• Familiarity with patient administration policies, particularly confidentiality and case management processes.
• Ability to manage daily workflow, handle coding tasks, and identify potential financial risks (e.g., lack of authorisation).

Note: Internal employees on a fixed-term contract are required to apply using an external candidate profile.

Click here to apply

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