Clinical Accountant Facilitator - Rustenburg OverviewReferenceCAF1SalaryZAR/monthJob Location- South Africa -- Bojanala Platinum District -- RustenburgJob TypePermanentPosted26 June 2023Closing date07 Jul 2023 23:59One of our clients in the Health Care industry has a permanent vacancy available for a Clinical Accountant Facilitator. Must live in or be willing to relocate to the Rustenburg area.Job Description:Remote verification of the eligibility of cover within available benefits as per scheme rules, clinical protocols and funding guidelines.Strict adherence to benefits, scheme rules, clinical protocols and funding guidelines across all services and authorisation categories.Effective and accurate communication to all relevant stakeholders regarding the outcome of authorisation requests.Issuing of authorisations based on received requests.Engagement with referring doctors and client on-site case managers to obtain relevant information to facilitate the authorisation decision and/ or hospital update for e.g., clinical history, pathology and radiology reports.Attending to escalations from providers and other on-site stakeholders including but not limited to union representatives, client HR, client clinical case managers or other healthcare professionals.Build and maintain relationships with all stakeholders (union groups, executives at clients, etc).Coordinate and manage all activities within the assigned client.Attending clinical review meetings that are held within the key account client's environment for e.g., the monthly client hospital, doctor and occupational case manager meetings.Perform site visits based on an agreed schedule to all relevant client clinics and hospitals.Clinical Risk Management to reduce the risks associated with hospital and other authorised services.Establish the presence of any co-morbid conditions from the beneficiary and/ or client case manager.Referral to member management and care co-ordination if co-morbid conditions are present for intervention and follow-up.Assist members with identification of and access to specialists who render services within the medical scheme's reimbursement rate.Prepare and present cases for escalation to the Senior Specialist Clinical Governance for discussion and resolution with the Clinical Committee and/ or Medical Advisors.Provide member care and education to patients with and without chronic conditions who need to participate in any of the registered active disease management programs.Provide remote support to pre-authorisation call centre as and when required.Skills and Competencies Required:Minimum 2-3 years' experience within a managed healthcare or medical scheme environment.Sound knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e., ICD10's, CPT4, NRPL, PMB conditions and clinical protocols.Thorough, well-grounded clinical knowledge of the pre-authorisation and case management of hospital admissions (including Length of Stay and Level of Care), as well as the pre-authorisation of in-rooms procedures and other supplementary healthcare services that requires pre-authorisation in accordance with the scheme rules and benefit structure.Extensive clinical knowledge related to all aspects of patient management.Ability to accurately update and maintain information related to in-hospital cases.Demonstrated ability to manage a portfolio of hospital cases.Solid understanding of value-based care.Outcome focused with the ability to manage competing demands.Excellent verbal and written communication skills.Computer literate - MIP Application System experience will be advantageous.Customer service orientation and an ambassador for organisation and the contracted clients.Ability to liaise with external parties - clinicians, members, union representatives and client HR - and to make decisions.Demonstrated ability to effectively deal with emotionally charged and stressful situations.Self-motivator and the ability to work effectively in an independent environment.Good organisational and task prioritisation skills.Outstanding multitasking skills.Ability to research and analyse information.High degree of accuracy and attention to detail.Compile and submit relevant reports in accordance with strict deadlines.Results orientated.Maintaining confidentiality of information.Valid drivers license and willing to travel.Qualifications:Enrolled/ Registered Nurse.Valid registration with SANC.#J-18808-Ljbffr