Authorization & Claims Clerk

Mediclinic; George; On-site; ZAR 300,000 - 520,000; Full time

Job summary

Mediclinic George in George, South Africa, is seeking a dedicated administrator to minimise financial risk by ensuring authorisation and re-authorisation of all cases through effective communication between relevant parties. The role requires attention to coding standards and compliance with contracts and legal aspects, working on-site.

Responsibilities include obtaining authorisation, capturing data, and identifying risk cases to safeguard paid claims.

Qualifications

• DESIRED EDUCATION: Relevant Short Courses and Certificates.
• DESIRED EXPERIENCE: Experience in a similar position.

Responsibilities

• 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

Skills

Funder Contracts

AS400 System

Medical Narratives

Clinical Coding

EMS messaging

Statutory acts

Patient confidentiality

Case management

Education

Relevant Short Courses and Certificates

Job description

Mediclinic George in George, South Africa, is seeking a dedicated administrator to minimise financial risk by ensuring authorisation and re-authorisation of all cases through effective communication between relevant parties. The role requires attention to coding standards and compliance with contracts and legal aspects, working on-site.

Responsibilities include obtaining authorisation, capturing data, and identifying risk cases to safeguard paid claims.