Clinical Governance Administra

2 weeks ago

Centurion, Gauteng, South Africa Health Solutions Full time

Introduction


Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value.

We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.


Role Purpose


To be responsible for non-clinical functions and indexing and routing of documents referred to the department, oversee the exceptions and exgratia claims process, and problem shoot/identify claims errors/facilitate the manual claims process.


Requirements:

  • Matric.
  • Minimum of 1 to 2 years of relevant administrative experience.
  • An excellent understanding of the Scheme's benefit design rules would be an advantage.
  • Knowledge of the Oracle system is essential.
  • Knowledge of clinical coding and prescribed minimum benefits and Designated service provider rules would be an advantage.
  • Firsttime query resolution on admin duties.
  • Excellent communication skills (verbal & written.

Duties & Responsibilities

  • Assessment of clinical and nonclinical interactions (i.e. calls, correspondence, and captures) of Case Managers, to measure the level of service provided to members and service providers.
  • Utilise IT systems effectively, to ensure the accuracy of documentation.
  • Perform clerical functions involving the compiling and arranging of data.
  • Complete documentation as per departmental guidelines in order to meet client needs.
  • Perform an efficient and accurate administrative function.
  • Take ownership of escalated and unresolved queries and ensure they are resolved timeously and effectively.
  • Take ownership of all queries and ensure that they are resolved timeously and effectively.
  • Prepare, sort and capture data accurately and efficiently.
  • Adhere to policies and procedures and take corrective action where necessary.
  • Comply with all the workplace policies and procedures.
  • Identify risks to the company and escalate accordingly.
  • Minimise the company's loss by controlling excessive wastage.
  • Maintain effective client relationships to ensure successful service delivery and support.
  • Escalate unresolved queries to the correct area to minimise user delay.
  • Monitor customer delivery constraints and escalate exceptions to management.
  • Maintain positive and productive relationships with key clients.
  • Deal with clients in a competent, efficient, and professional manner in accordance with quality standards.
  • Adhere to all procedures and processes to improve service delivery.
  • Drive and support effective teamwork within the department.
  • Engage in appropriate training interventions to promote own professional development.
  • Ensure to demonstrate the company's values on a daily basis.

Competencies

  • Business acumen
  • Client/stakeholder commitment
  • Drives for results
  • Leads changed and innovation
  • Motivating and inspiring team
  • Collaboration
  • Impact and influence
  • Selfawareness and insight
  • Diversity and inclusiveness
  • Growing talent

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