Medical Professional jobs

Job Title: Confirmations clerk

Reports to: Patient Services Manager

JOB SUMMARY

To ensure the authorisation and re-authorisation of hospital cases by effectively communicating with the relevant parties, thus minimising financial risk to the business.

REQUIREMENTS

Minimum Qualification:

• Relevant NQF 5 qualification (Clinical)

Added Advantage:

• Related Post Matric Qualification (i.e coding)

Minimum Experience:

• 1-2 years’ experience within a Medical Scheme / private hospital environment
• Demonstrable experience working with patients, doctors and medical schemes
• Working experience of SAP or similar platform

Key Competencies:

• Hospital Operations
• Medical Schemes standards and processes
• Confirmations and Authorisations
• Working knowledge of ICD codes
• Computer literacy

DELIVERABLES:

• Obtain authorisation and re-authorisation daily for all identified Medical Scheme patients
• Obtain authorisation within 8 hours for all unplanned Medical Scheme patients
• Obtain authorisation on the first Monday following an admission of an Emergency Unit patient over a weekend
• Capture data, accurately and timeously, and communicate to all parties
• Comply with ICD-10 and CPT-code books
• Escalate to Senior Case Manager for resolution with patient where authorizations remain pending
• Liaise with patients (and family members) regarding suspended, pending and declined authorizations, and ensure that the Case Manager is informed
• Communicate with Doctors regarding certain codes, for example, exclusion codes to ensure that Doctor is informed of decline by medical scheme
• Liaise with Mothers (or guarantors) regarding the completion of the registration forms for new-born babies with the Medical Scheme/s and follow up to ensure registration has been completed by the Medical Scheme
• Develop relationships with Doctors to ensure they are kept up to date with any issues with medical aids schemes