Claims Confirmations Specialist: Authorisation & Risk

Mediclinic International; Bloemfontein; On-site; ZAR 180,000 - 240,000; Full time

Job summary

Mediclinic Southern Africa is recruiting to ensure the authorisation and re-authorisation of identified patient cases, with data capture and active referral of risk cases to minimise financial exposure. The role requires adherence to Level 2 clinical coding guidelines and compliance with contract-based procedures using available systems.

The successful candidate will navigate funder contracts and medical aid narratives, supporting efficient claim processing and patient administration while

Qualifications

• Essential education: Grade 12 or equivalent.
• Desirable: None stated beyond the basics.

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

Medical aid requirements/narrations

Rules and regulations

Clinical coding Level 2

B2B EMS

Statutory acts awareness

Patient administration policies

Daily workflow management

Identify financial risks

Education

Grade 12 or equivalent

Tools

AS400 system

Job description

Mediclinic Southern Africa is recruiting to ensure the authorisation and re-authorisation of identified patient cases, with data capture and active referral of risk cases to minimise financial exposure. The role requires adherence to Level 2 clinical coding guidelines and compliance with contract-based procedures using available systems.

The successful candidate will navigate funder contracts and medical aid narratives, supporting efficient claim processing and patient administration while