The position reports to the Patient Admin Manager and will be responsible for the following performance areas:
- Responsible for the case management with the hospital
- Interactions with medical schemes to ensure authorizations are provided timeously
- Verification of clinical coding
- Ensures accurate application and interpretation of specialized wards criteria
- Provides support for the management of alternate fee structures
- Liaison with doctors on funder requirements when necessary
- Continuous performance and quality management
- Interpretation and implementation of scheme benefit rules
- Maintains client service principles to ensure client expectations are met
Bachelor’s Degree in nursing
- Registered with the South African Nursing Council as a Professional Nurse or Registered Nurse
- Experience in a managed healthcare environment
- Knowledge of coding and coding regulations
- Intermediate knowledge of Microsoft Office Suite
- Knowledge of the rules and regulations regarding medical aid schemes
- Knowledge of Trifour system will be an advantage
- Independent problem-solving and decision-making kills.
- Good accuracy and attention to detail skills in order to maintain high standards of work output
- Ability to function well within a team.
- Understand the interrelationships between business processes
- Maintains a customer-focus mindset that acknowledges the value of the client.
A Consultant will be in touch if you are shortlisted for the position. Please consider your application unsuccessful should you not have been contacted within 2 weeks. We will keep your CV on our database and contact you should you match the criteria of any other vacancies.