Sound knowledge of the Coding Systems: ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation
Excellent business writing & communication skills with exceptional telephone etiquette
Must have strong organisational awareness to anticipate the impact of actions on other groups.
Time Management & good administration skills
Effective conflict resolution skills and the ability to work under pressure
Must be a strong team player and results driven
Computer literacy (MS Office and Medical Administration system)
Duties and Responsibilities
Contacting of members and building of positive relationships with the members to achieve positive outcomes.
Analyse and interpret reports, clinical results, and patient history information to provide an action plan per patient.
Ensure adherence to Scheme Rules on all authorisations and clinical updates
Effective handling of Internal/External Clinical Queries Communicate with members and service providers to address disease management matters
Assist with Health Risk Management Monitoring & Management of hospital re-admissions
Compile & submit detailed reports to the Scheme on costs and patient’s progress
Educate members on their chronic conditions via email or telephonically.
Support the Service Manager and HOD on any projects related to risk management.
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