MEDICLINIC | Confirmations Clerk X1

MEDICLINIC | Confirmations Clerk X1

Closing date: 03/08/2021
Number of positions: 1
Recruiter name: Celeste Diana Isaacs
Reference number: 15803
Permanent

Mediclinic Milnerton | Milnerton, Cape Town | South Africa

MAIN PURPOSE OF JOB

To minimize financial risk by ensuring authorization and re-authorization of all cases through effective communication between relevant parties.

REQUIRED EDUCATION

ESSENTIAL EDUCATION:  Grade 12 or equivalent

DESIRED EDUCATION: None 

REQUIRED EXPERIENCE

Essential minimum experience: None

DESIRED EXPERIENCE: Experience in Clinical Environment

KEY RESPONSIBILITY AREAS

Obtain authorisation and re-authorization for all identified patients to ensure fully paid claims

Capture data and communicate to all parties

Identify and refer risk cases to minimize financial risks

Adhere to clinical coding standards as per Level 2 coding guideline

Ensure compliance to the confirmation procedure contracts and legal aspects by utilizing available resources and systems

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 the status of authorizations and use for trouble, shooting)
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 authorization; 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.

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