The Group is focused on providing specialist-orientated, multidisciplinary services across the continuum of care in such a way that the Group will be regarded as the most respected and trusted provider of healthcare services by patients, medical practitioners, funders and regulators of healthcare in each of its markets.
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
Matric/ Grade 12 or equivalent
Required Experience
- 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 trouble, shooting)
- Computer literate (Microsoft Office)
- 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.)
