Patient Advocacy Representative

Mediplus SA's Clinical Benefits Agent is responsible for managing pre-authorizations, overseeing case management, and facilitating communication among stakeholders to ensure seamless patient care. This role requires strong negotiation and communication skills, as well as proficiency in using case management software, ICD-10 codes, and procedure codes.

• Manage Pre-Authorizations: Evaluate and process medical pre-authorization requests, ensuring timely decision-making.
• Coordinate Case Management: Monitor and manage patient cases, coordinating care plans with healthcare providers to optimize resource utilization.
• Act as a Liaison: Facilitate communication among members, client relations, and healthcare providers to resolve inquiries and issues.
• Negotiate Tariffs: Negotiate cost-effective healthcare tariffs, adhering to company policies and regulations.

Job Requirements:

• Matric with mathematics.
• Diploma in risk or clinical nursing advantageous.
• Knowledge of Anatomy and Physiology.
• Previous experience in case management, pre-authorizations, or a similar role strongly advantageous.
• Strong negotiation and communication skills.
• Ability to manage multiple tasks and work under pressure.
• Knowledge of healthcare regulations and compliance requirements strongly advantageous.
• Proficiency in using case management software, ICD-10 codes, and procedure codes strongly advantageous.
• Excellent interpersonal skills and attention to detail.
• Reliable, professional, and able to work collaboratively within a diverse team.
• Knowledge of COID, medical aid rules, and managed healthcare policies.