Job Openings at AfroCentric Group

Brief Role Description

• To ensure the accurate issuing of appropriate pre-authorisations that meets the requirements of clinical appropriateness, medical necessity and clinical risk management

Duties and responsibilities for this role:

• Providing Accurate Pre- Authorisation in accordance to coding principles, scheme rules and benefits, and managed care policies and processes
• Providing Clinical review and resolution on call centre queries
• Review and process auth related claims in accordance with coding principles, scheme rules and benefits, and managed care policies and processes
• Communicate with Stake holders  
• Writing of clinical reports
• Maintain clinical documents and processes
• Assist with training and sharing of knowledge within the team and clients

Competencies

• Attention to Accuracy and Detail
• Ability to negotiate and influence
• Ability review clinical request and advise scheme and colleagues
• Ability assess claims for clinical correctness according to authorisation provided
• Relevant systems knowledge and application
• Problem Solving
• Customer centred and Focussed
• Computer Technology Skills
• Communication Skills
• Clinical reporting skills
• Business Writing Skills
• Numerical Ability

Qualifications:

• A formal nursing qualification and registration/enrolment with SANC or a formal healthcare professional qualification (Registered / Enrolled Nurse).

Experience

• A minimum of 2-3 years’ experience in a general medical and general surgical ward. At least 1 of these years at a Private institution.
• Trauma/ER experience will be an advantage. Previous Managed Healthcare experience in a call centre environment will be to your advantage.
• SANC Membership

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Brief Role Description

• To audit, authorise and process the accurate payment of hospital and case management claims. Ensuring that patient treatment, material and equipment usage for each claim is in accordance with claim rules and regulations.

Duties and responsibilities for this role:

• Review and process auth related claims in accordance with coding principles, scheme rules and benefits, and managed care policies and processes
• Providing Clinical review and resolution on call centre queries
• Communicate with Stake holders  
• Writing of claims reports
• Maintain clinical documents and processes
• Assist with training and sharing of knowledge within the team and clients
• Providing Accurate Pre- Authorisation in accordance to coding principles, scheme rules and benefits, and managed care policies and processes

Competencies

• Attention to Accuracy and Detail
• Ability to negotiate and influence
• Ability review clinical request and advise scheme and colleagues
• Ability assess claims for clinical correctness according to authorisation provided
• Relevant systems knowledge and application
• Problem Solving
• Customer centred and Focused
• Computer Technology Skills
• Communication Skills
• Clinical reporting skills
• Business Writing Skills
• Numerical Ability                                                                                   

Qualifications:

• A formal nursing qualification and registration/enrolment with SANC or a formal healthcare professional qualification (Registered / Enrolled Nurse).

Experience

• 2 – 3 years Manage Care experience, of which a minimum of 2 years should have been in an clinical auditing role
• SANC Membership