Job Description

Obtain authorizations for after-hours admissions



Daily capture of all clinical information such as Authorizations Number, Length of Stay (LOS) and Level of



Care (LOC)



Daily monitor and review of Confirmations



Reports Validation of all authorizations and memberships



Validation and confirmation of membership, authorization, benefits and limits on Theatre Slate and timeous distribution thereof to all stakeholders



Follow up on all baby registrations to ensure that dependents are registered within 7 working days of admission.



Timeous and effective communication of Funder responses and requirements to all stakeholders.



Serve as a liaison between Case Managers, Medical Funders, and various stakeholders.



Assist with forwarding supporting documentation such as but not limited to X Rays, MRI's, Pathology results, Scope Reports, Letters of Motivation (LOM), Caesarian Form, etc. to Funders



Timeous follow up and escalation to Funders on unapproved Authorizations, LOS and LOC to ensure that the target is maintained.



Effective & timeous communication of financial risks, such as non-declaration, benefit limits on Medical Aids, low option medical aid plans, declined authorizations, requests for letters of motivations to internal and external stakeholders. Liaise with patients on declined authorizations, co-payments, benefit limits, etc.



Assist with timeous escalation of cases within turnaround time for LOS, LOC and Codes that are not approved to maintain the target of accurate final billing and submission.



Follow up with external service providers and stakeholders on outstanding documentation required by Funders for the accurate final billing and submission of files to maintain targets.



Following up and resolving queries to ensure that the targets are maintained.



Application of clinical knowledge in reviewing ICD and CPT coding of patient accounts.



Adherence to deadlines.



Administrative tasks.



Adhoc and administrative duties as requested by line Manager.



Ability to stay abreast of industry trends and knowledge.



Keep up to date and compliance with Melomed's Policies and Procedures.



Maintain and sustain working key internal and external relationships

Core Competencies:

Education:

Grade 12 or equivalent NQF4 qualification



Certificate in ICD 10 and CPT Coding (Preferred)

Experience:

Minimum 3 years relevant experience in a multidisciplinary hospital



Experience in National Hospitals Network (NHN) Billings would be preferred

Knowledge & Skills:

Computer Literacy



Strong Administrative Skills



Knowledge Alternate Reimbursement Models



Knowledge of applicable statutory acts such as Consumer Protection Act; PMB; POPIA, etc.



Excellent communication skills (written and spoken)