Ophthalmology Medical Authorisation Specialist

AF Consulting; Hermanus; On-site; ZAR 180,000 - 240,000; Full time

Job summary

AF Consulting in the Western Cape (Hermanus) is seeking an Authorisation Clerk (Specialist Medical Practice) to manage medical aid authorisations for consultations, procedures and surgeries. You will verify ICD-10 codes and submission details and liaise with schemes, hospitals and patients to resolve queries.

The role requires Matric, experience in specialist medical settings and strong admin, communication and confidentiality.

Qualifications

• Matric / Grade 12 required.
• Experience in a specialist medical practice essential.
• Experience with medical aid authorisations essential.
• Knowledge of ICD-10 and procedure coding essential.
• Knowledge of medical billing advantageous.
• Experience in creditors and debtor administration advantageous.
• Computer literacy with medical practice management software.
• Excellent administrative and organisational skills.
• Strong verbal and written communication skills.
• Ability to work accurately under pressure.
• High level of professionalism, integrity, and confidentiality.

Responsibilities

• Obtain and manage medical aid authorisations for consultations, procedures and surgeries.
• Verify ICD-10 codes, procedure codes, and practice information before submission.
• Follow up on pending, outstanding, and rejected authorisations.
• Maintain up-to-date knowledge of medical aid rules, funding protocols and authorisation requirements.
• Liaise with medical schemes, hospitals, and patients regarding authorisation queries.
• Ensure authorisations are obtained within required turnaround times.
• Communicate with patients regarding co-payments, shortfalls and financial responsibilities.
• Follow up on outstanding patient accounts in accordance with practice procedures.
• Assist with debtor management and age analysis.
• Maintain accurate patient and financial records.
• Work with Ophthalmologist, Practice Manager and reception team for a seamless patient experience.
• Adhoc admin duties.

Skills

Administrative skills

Verbal communication

Written communication

Attention to detail

Time management

Confidentiality

Computer literacy

Medical practice software

Education

Matric / Grade 12

Tools

Medical practice management software

Job description

AF Consulting in the Western Cape (Hermanus) is seeking an Authorisation Clerk (Specialist Medical Practice) to manage medical aid authorisations for consultations, procedures and surgeries. You will verify ICD-10 codes and submission details and liaise with schemes, hospitals and patients to resolve queries.

The role requires Matric, experience in specialist medical settings and strong admin, communication and confidentiality.