Consultant: Clinical Administration (MHC) - Centurion

An exciting opportunity for an analytical and detail orientated individual exists for a Clinical Administrator position! The successful candidate will meet with below requirements and utilize their excellent planning and administrative skills to provide an effective and efficient administrative support service to the Managed HealthCare group.

MINIMUM REQUIREMENTS:

• Grade 12
• A completed course in Business Writing preferred
• A minimum of 2 - 3 years’ experience in Medical Scheme Administration or Managed HealthCare
• A Nursing or Pharmacy Assistant qualification essential
• Knowledge of the coding systems: ICD10 and CPT4 principles
• Computer literacy essential (MS Office and Medical Administration system)

KEY RESPONSIBILITIES INCLUDE:

• Receive and respond to internal and external correspondence; queries from suppliers, service providers, clients and other employees as to solve queries in an efficient and effective manner
• Capture and allocate authorisation requests on the system, as per request from members and service providers to ensure that the most cost-effective treatment is authorised
• Compile and maintain MHC statistics to ensure accurate record keeping
• Communicate decisions of the Clinical Committee to members/providers
• Generate and circulate reports on the system to assist the Managed Healthcare team in managing the SLA as well as to assist in risk management decisions.
• Order/distribute stationary for MHC personnel to have the necessary stationary to perform their tasks
• Compile all minutes/recording of meetings as requested by Management.
• Collate and circulate reports on the system to ensure that outstanding authorisations and enquiries are followed up on by the Case Managers and Pre Auths
• Other Administrative functions as required by Management