
Website Mediclinic
Job Description:
To oversee and supervise the claims department and ensure accurate reimbursement of claims based on agreed medical schemes contracts and ER24 clinical protocols
Job Responsibilities:
- Compile weekly, month-end and Board reports
- Manage and maintain claims administration system
- Manage and mitigate functional risks
- Manage the operations of the claims department
- Lead and manage the people in the team
- Build and maintain stakeholder relations
Job Requirements:
- Understanding and application of all relevant statutory and non-statutory regulations, including but not limited to Council of Medical Aid, HPCSA, PMB, etc.
- Knowledge and application of relevant computer software packages including Microsoft Office Packages (Excel), SAP
- Demonstrate a good understanding of the requirements by medical schemes or EMS providers to obtain authorisations and provide motivations on specific cases
- Demonstrate a solid understanding of the Funder Relations environment, with specific reference to the rules and regulations regarding funder contracts, and the application thereof
- Knowledge and application of all claims principles, processes, policies and procedures
- Identification of administrative inefficiencies and the ability to implement improved processes
- Demonstrates competence on the ER24 Claims System (SAP) and the application thereof
- Understanding and correct application of claims governance and risk management
- Demonstrates competence in the appropriate application of clinical codes (ICD 10) and finalisation thereof
Qualification & Experience:
- 2 years management/supervisory experience
- Good working knowledge of the intricacies of the private healthcare industry
- Bachelor’s degree or diploma with relevant private healthcare experience
- 5 – 10 years experience in the private healthcare industry;2 -3 years experience in a medical claims environment
Job Details:
Company: Mediclinic
Vacancy Type: Full Time
Job Location: Stellenbosch, Western Cape, South Africa
Application Deadline: N/A
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