Medical Claims Confirmations Specialist – On-site

Mediclinic Group; Polokwane; On-site; ZAR 50 000 - 200 000; Full time

Job summary

A healthcare provider in Polokwane is seeking a Candidate to manage authorisations and minimise financial risks. Responsibilities include ensuring fully paid claims and maintaining compliance with clinical and legal standards. Ideal candidates will have Grade 12 and experience in a clinical environment is desirable. The position is full-time and requires strong communication and administrative skills.

Responsibilities

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

Skills

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)

Computer literate (Microsoft Office)

Relevant aspects of applicable statutory acts

Patient Administration policies and procedures

Daily workflow; managing deviances; coding

Identify possible financial risks

Education

Grade 12 or equivalent

Job description

A healthcare provider in Polokwane is seeking a Candidate to manage authorisations and minimise financial risks. Responsibilities include ensuring fully paid claims and maintaining compliance with clinical and legal standards. Ideal candidates will have Grade 12 and experience in a clinical environment is desirable. The position is full-time and requires strong communication and administrative skills.