Netcare
The confirmations clerk communicates with funders and internal managed healthcare teams regarding confirmations of authorisations and available benefits. The incumbent will be responsible for confirming authorisations, length of stay, clinical codes and level of care for patients.
ROLE SUMMARY
- The confirmations clerk communicates with funders and internal managed healthcare teams regarding confirmations of authorisations and available benefits. The incumbent will be responsible for confirming authorisations, length of stay, clinical codes and level of care for patients.
KEY WORK OUTPUT AND ACCOUNTABILITIES
DISRUPTIVE INNOVATION
Confirmations process
• Manage that all medical aid patients have the necessary authorisation for hospital admission.
• Systematic follow-up of all outstanding authorisations.
• Ensure all relevant information received from the insurance provider is accurately reflected on the SAP system.
• Control of incomplete, inaccurate and delayed confirmation data as these have ramifications for accurate reporting of billing financials.
• Working within day end parameters to ensure that there is flow of files from case management to final billing.
• Manage and escalate outstanding funder responses.
• Secure requested letter of motivations from doctors when applicable.
• Collaborate with the Hospital Billing Coordinator on following up outstanding hospital documentation.
Communication
• Maintain Netcare digital system of communications strictly.
• Be courteous and professional in all interactions with funders and other stakeholders.
General
• Assist with any adhoc duties assigned by the BOC Case Manager/ Billings Manager.
• Work collaboratively alongside case managers, file assessors and coders for effective task resolution.
• Be agile in approach as Netcare moves to digitally enabled systems.
TRANSFORMATION OF OUR SOCIETY
Personal and professional development
• Assume responsibility for own personal and professional development.
• Keep up to date with Netcare’s evolving policies and procedures.
• Maintain and sustain effective working relationships with all customers and colleagues.
POPIA
• Always maintain patient confidentiality. SKILLS PROFILE
EDUCATION
Required
• Grade 12 or equivalent NQF Level 4 Qualification.
WORK EXPERIENCE
Required
• Experience in a healthcare setting.
• Experience with any clinical or healthcare related billing systems.
KNOWLEDGE
Required
• Computer literacy
PHYSICAL REQUIREMENTS
In the event of any physical or psychological limitation that may impair the employee’s ability to perform the required job function, the employee must consult the employer for reasonable accommodation.