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Healthcare Benefits Manager
1 week ago
The Talent Room is seeking a skilled Clinical Benefits Agent to manage pre-authorizations and oversee case management, facilitating communication between members, client relations, and healthcare providers.
Key Responsibilities- Evaluate and process requests for pre-authorizations, ensuring all necessary information is gathered to make informed authorization decisions.
- Communicate authorization decisions to healthcare providers and members promptly.
- Monitor and manage individual patient cases, ensuring appropriate care and efficient use of resources, coordinating with healthcare providers to develop and implement care plans.
- Negotiate tariffs and fees with healthcare providers to ensure cost-effective care for members, maintaining accurate records of tariff agreements and monitoring adherence to agreed terms.
- Identify potential risks associated with patient care and preauthorization processes, developing and implementing strategies to mitigate identified risks and monitoring their effectiveness.
- Matric with mathematics
- Diploma in business, risk, or clinical nursing advantageous
- Knowledge of Anatomy and Physiology advantageous
- Previous experience in case management, pre-authorizations, or a similar role strongly preferred
- Strong negotiation and communication skills
- Ability to manage multiple tasks and work under pressure
- Knowledge of healthcare regulations and compliance requirements strongly preferred
- Knowledge of different COID and Medical Aid rules and managed health care policies
- Proficiency in using case management software, ICD10 codes, and procedure codes strongly preferred
