Medical Management Consultant – 12-Months Fixed Term Contract – Johannesburg
Medical / Emergency / Health / Lab
JHB North, Johannesburg – Gauteng
Medical Management Consultant – 12-Months Fixed Term Contract – Johannesburg
Salary: up to R501,775.00pa
Overview:
Responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.
Minimum Requirements and Experience:
- Bachelor’s Degree/Advanced Diploma in:
- Health Sciences /Medical related qualification.
- Registration with HPCSA/SANCA. (Essential)
- Relevant 3 years’ experience in a Medical related environment.
- Knowledge of motor vehicle accident legislation.
- Competencies:
- Claims management process/ processes and systems.
- Medical product management
- Medical bill reviewing
- Medical case management
Key Performance Areas:
Medical Management:
- Conduct medical assessment and compile injury assessment reports.
- Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
- Incorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by The Company and / or any that is considered reasonable.
- Pre authorise submitted claims aligned to The Company clinical guidelines including The Company formularory, treatment protocols and related tarrifs.
- Escalation of complex cases for multi disciplinary review and adjudication.
- Participate in the consultations process on the implementation of medical claims processes.
Exception Handling:
- Ensure the implementation and maintenance of a formal exception handling process within the medical management.
- Maintain the documentation and regular updating of the exception handling process.
- Maintain the implementation an unusual occurrence procedures.
Reporting:
- Track and report against set objectives and targets.
- Report on emerging risks.
- Provide ad hoc reports on process improvement initiatives.
- Produce documents, briefing papers, reports and presentations.
Stakeholder Management:
- Deal with/and respond to correspondence.
- Maintain healthy relationships with all stakeholders.
- Follow up and resolve all queries, following up and making recommendations on which corrective actions are appropriate.
- Follow up and feedback to all stakeholders to keep them updated on the status of a query.
- Respond to queries within the predefined turnaround times.
NB: Should you not be contacted within 2 weeks of your application, please consider it as unsuccessful.
