Medical Services Organisation jobs

1. PRIMARY RESPONSIBILITIES

To provide timeous, efficient liaison between funders, hospital and patient, confirming membership of

patients with Medical Aids and/or Managed Care Organisations and obtaining authorization numbers

where applicable.

2. KEY PERFORMANCE AREAS (KPA)

• Patient Confirmations and Authorisations
• Continuous Quality Improvement (CQI)

3. SPECIFIC RESPONSIBILITIES AND MEASUREMENT

3.1 KEY PERFORMANCE AREA 1: PATIENT CONFIRMATIONS AND

AUTHORISATIONS

• Receive admission details from admission clerks.
• Ensure that all Authorisations are received and confirmed with the relevant funder for patients being admitted to our hospital
• Confirmations must be received the same day as admission with the possible exception of weekend admissions, which must be given the highest priority on Monday morning or the day after a public holiday
• Where confirmations are delayed, strict and regular follow up must be maintained to ensure that the hospital does not suffer losses in the case of fraudulent admissions
• Notify relevant departments and patients of any irregularities regarding the patients authorisation e.g. declined status, suspended status etc.
• Ensure level of care (LOC) and length of stay (LOS) obtained and re-authorisations received from the fund are updated on SAP system.
• Obtain and submit letter of motivation (LOM) or a treatment plan to funders
• Ensure all necessary documentation is faxed, emailed to funders as necessary e.g. Injury reports, PMA reports
• Refer any queries or problems immediately to the Manager, particularly in the case of delays and where a short stay is expected
• Liaise with Case Manager in the event of a Managed Care patient being admitted (e.g. identified by the medical aid name) handing over patient details for internal case management follow up
• File all written confirmations in the patients file
• Enter all confirmation details into the computer system
• Maintain a schedule of all confirmations and in particular those outstanding and advise
• Patient Administration Manager/Credit Manager on a daily basis so that priorities can be set for follow up
• Maintain a professional and sound relationship with contact persons at medical
• aids/managed care organisations
• To assist with other duties in the Patient Administration or Credit Department as maybe requested from time to time and within the scope of knowledge and expertise of the incumbent

3.2 KEY PERFORMANCE AREA 2: CONTINUOUS QUALITY IMPROVEMENT (CQI)

• Constantly be aware of work process problems or bottlenecks that prevent the achievement of goals, objectives and targets
• Take appropriate action in improving any process that will allow the reduction of cost and/or improvement to quality, service and productivity

4. KEY OUTPUTS

• Consistently achieve agreed standards of timeous receipt of confirmations
• Building of sound relationships with medical aids contact persons
• Building of sound relationships with doctors’ rooms receptionists
• Building of sound relationships with admission and credit department staff
• Building of sound relationships with all other hospital departments with the highest cooperation levels
• Develop and maintain a sound working relationship with your manager

5. INHERENT REQUIREMENTS OF THE POSITION

• Must have at least 2 years of confirmations experience
• Knowledge of funders and private healthcare industry

6. MINIMUM QUALIFICATION

• Grade 12 (Matric)
• A nursing qualification (an advantage)

7. COMPETENCIES REQUIRED

• Ability to engage various stakeholders and must be able to deliver exceptional customer service.
• Computer literate, accurate, stringent attention to details

8. PERSONAL CHARACTERISTICS

• Organised and able to work well under pressure
• Displays initiative and able to work independently
• Customer-orientated with good interpersonal and communication skills including excellent telephone skills

Job Type: Full-time

Ability to commute/relocate:

• Abaqulusi, KwaZulu-Natal: Reliably commute or planning to relocate before starting work (Required)

Work Location: In person