Authorization & Claims Specialist

Mediclinic International; Cape Town; On-site; ZAR 240,000 - 360,000; Part time

Job summary

Mediclinic Milnerton in Cape Town seeks a dedicated professional to ensure authorisation and re-authorisation of cases, enabling timely paid claims. The role requires strong coordination with funders, clinics and admin teams to mitigate financial risk.

Essential education is Grade 12. Experience in a clinical environment and familiarity with AS400 patient administration, funder contracts, clinical coding (Level 2) and related regulatory acts will help you succeed.

Qualifications

• Funder contracts and medical aid requirements
• AS400 patient administration experience
• Rules regarding funder contracts and coding standards
• Clinical coding (Level 2) knowledge
• B2B EMS familiarity for authorisations
• Awareness of statutory acts affecting claims
• Patient confidentiality and admin policies
• Daily workflow and case management processes

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 admin

Funder contracts rules

Clinical coding L2

B2B EMS

Statutory acts

Patient confidentiality

Daily workflow

Case management

Education

Grade 12

Job description

Mediclinic Milnerton in Cape Town seeks a dedicated professional to ensure authorisation and re-authorisation of cases, enabling timely paid claims. The role requires strong coordination with funders, clinics and admin teams to mitigate financial risk.

Essential education is Grade 12. Experience in a clinical environment and familiarity with AS400 patient administration, funder contracts, clinical coding (Level 2) and related regulatory acts will help you succeed.