Confirmations Clerk

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

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

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)


• 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.)

All applicants will be considered, with the understanding that preference will be given in accordance with the Employment Equity Plan of Mediclinic Southern Africa, as well as internal applicants/employees that meet the minimum requirements.

Please note if you are an internal employee on a fixed term contract please apply using an external candidate profile and not your employee profile

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