A passion for wellness, community, sustainable design and smiles.
Why do we do what we do? We respect that you, like us, believe that travel can serve a purpose. You want us to be honest and keep it real, with genuine actions that merge the two platforms of wellness and sustainability to promote personal health, and the health of our planet. Experience some...
Read more about this company
A financial services business is seeking to appoint a Consultant Medical Management - 1 Year Contract.
The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing. Strong claims management experience is essential
Qualifications:
Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
Registration with HPCSA/SANCA
Medical management
Conduct medical assessment and compile injury assessment reports.
Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
Incorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the RAF and / or any that is considered reasonable.
Pre-authorise submitted claims
Escalation of complex cases for multi-disciplinary review and adjudication.
Participate in the consultations process on the implementation of medical claims processes.
Experience:
Relevant 3 years’ experience in a Medical related environment
Claims management process/ processes and systems. - must be very strong on Claims Management
Medical product management
Medical bill reviewing
Medical case management
Complex problem identification, solving and decision making
Gmail
Yahoomail