Confirmations Clerk

Mediclinic Emfuleni; Vanderbijlpark; On-site; ZAR 50,000 - 200,000; Full time

Job summary

A healthcare facility in Vanderbijlpark seeks a candidate to manage authorisation and re-authorisation processes, ensuring minimized financial risks through effective communication and adherence to coding standards. Required is a Grade 12 education, while experience in a clinical setting is desired. Candidates should be proficient in relevant administrative systems and regulations.

Qualifications

• Grade 12 or equivalent required.
• Experience in a clinical environment desired.

Responsibilities

• Obtain authorisation and re-authorisation for identified patients.
• Capture data and communicate to all parties involved.
• Identify and refer risk cases to minimise financial risks.
• Ensure compliance with clinical coding standards.

Skills

Funder Contracts

Patient admin programmes on the AS400 system

Clinical coding (Level 2 coding)

B2B EMS

Computer literate (Microsoft Office)

Relevant aspects of applicable statutory acts

Patient Administration policies

Daily workflow management

Identify possible financial risks

Education

Grade 12 or equivalent

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

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.)