Confirmations Clerk (Cape Town) at Mediclinic

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

• Essential minimum experience: None
• 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 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.)