Confirmations Clerk

Mediclinic Sandton; Gauteng; On-site; ZAR 25 000 - 45 000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated individual to minimize financial risks through effective patient authorisation processes. In this role, you will ensure that all necessary authorisations are obtained, thus safeguarding the financial integrity of claims. You will be responsible for capturing essential data and communicating with various stakeholders to ensure compliance with clinical coding standards. This is an excellent opportunity for someone looking to grow in a clinical environment while playing a crucial role in patient administration and risk management.

Qualifications

• Grade 12 or equivalent education is essential.
• Experience in a clinical environment is desired.

Responsibilities

• Obtain authorisation and re-authorisation for patients.
• Capture data and communicate with all relevant parties.
• Adhere to clinical coding standards and compliance procedures.

Skills

Funder Contracts

Medical aid requirements/narrations

Clinical coding (Level 2 coding)

Computer literacy (Microsoft Office)

Daily workflow management

Identifying financial risks

Education

Grade 12 or equivalent

Tools

AS 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

1. Obtain authorisation and re-authorisation for all identified patients to ensure fully paid claims.
2. Capture data and communicate with all parties.
3. Identify and refer risk cases to minimise financial risks.
4. Adhere to clinical coding standards as per Level 2 coding guideline.
5. Ensure compliance with 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 AS system.
• Rules and regulations regarding funder contracts.
• Clinical coding (Level 2 coding).
• B2B EMS (electronic message system: check status of authorisations and use for troubleshooting).
• Computer literacy (Microsoft Office).
• Relevant aspects of applicable statutory acts (e.g., Patient Administration policies and procedures such as Patient Confidentiality, Visitation of external case managers, etc.).
• Daily workflow management, managing deviations, coding, and case management processes.
• Identify possible financial risks (e.g., no authorisation, insufficient LOS or LOC, etc.).