Overview
Clinical Agent/Pre-Authorization Jobs in Mbombela, South Africa at Mediplus SA
Position: Â Clinical Benefits Agent (Pre-Authorization)
Location: Mbombela
The Clinical Benefits Agent is responsible for managing pre-authorizations and overseeing case management to ensure optimal patient care and efficientresource utilization. This role involves facilitatingcommunicationbetween members, client relations, and healthcare providers, negotiating tariffs, managing risks, and coordinating air evacuations when necessary.
Key Responsibilities:
Pre-Authorizations:Evaluate, process, and communicate medical pre-authorization decisions.
Case Management:Monitor and manage patient cases, coordinate care plans, and ensure efficient resource use.
Communication:Act as a liaison among members, healthcare providers, and client relations, addressing inquiries and resolving issues.
Negotiation of Tariffs:Negotiate cost-effective healthcare tariffs, ensuring compliance with policies and regulations.
Risk Management:Identify and mitigate risks associated with patient care and authorization processes.
Compliance:Handle sensitive personal/medical information securely, adhering to Mediplus SA’s policies and the POPI Act.
Minimum Requirements:
Matric with Mathematics.
Diploma in business, risk management, or clinical nursing (advantageous).
Knowledge of anatomy, physiology, ICD
10, and procedure codes (strongly advantageous).
Experience in case management, pre-authorizations, or similar roles (preferred).
Strong negotiation,communication, andanalytical skills.
Proficiency in Microsoft Office Suite
Competencies:
Excellent interpersonal skills andattention to detail.
Reliable, professional, and able to work collaboratively within adiverse team.
Knowledge of COID, medical aid rules, and managed healthcare policies.
What We Offer:
Acollaborative workenvironment.
Opportunities forprofessional growth.
Competitive compensationand benefits.
Take the next stepin your career and become a vital part of Mediplus SA’s mission to deliverexceptional serviceto our members!
Apply with your CV, cover Letter and qualifications to. Please make your subject line”Clinical Benefits Agent”.
Note:
Only shortlisted candidates will be contacted.
Join Mediplus SA and make a meaningful difference in healthcare!
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Title: Clinical Agent/Pre-Authorization
Company: Mediplus SA
Location: Mbombela, South Africa
Category: Healthcare
