Confirmations Clerk at Melomed Private Hospitals

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

Requirements

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)