Registered with the South African Nursing Council as an Enrolled Nurse or Professional Nurse or with the HPCSA as an ILS or ALS qualified paramedic. Intermediate knowledge of Microsoft Office suite. Knowledge of the Scientific Nursing Process and associated procedures will be an advantage. Knowledge of the rules and regulations regarding medical aid schemes will be an advantage. Knowledge of clinical codes and coding policies. Knowledge of patient administration systems, policies and procedures will be an advantage. Experience in a Managed Healthcare environment will be a strong recommendation. Independent problem solving and decision making skills. Good accuracy and attention to detail skills in order to maintain high standards of work output. Ability to function well within a team. Understands the interrelationships between business processes. Maintains a customer-focused mindset that acknowledges the value of the customer. Utilises self-management techniques in order to proactively improve own performance. The ability to identify and demonstrate company values.
Responsible for the case management process within the hospital. Interacts with medical schemes to ensure that authorisations are provided timeously. Verification of clinical coding as per policies and procedures. Ensures accurate application and interpretation of specialised wards criteria. Provides support for the management of alternative 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.
Candidates, who are interested in applying for this position, can apply directly at https://mediclinic.erecruit.co.za Please ensure that your profile is complete and up to date with the latest information, before applying. For any online support, please contact the Mediclinic Career Centre at +27 21 861 1000.