Healthcare Benefits Specialist

5 days ago


Nelspruit, Mpumalanga, South Africa Mediplus SA Full time

Maintain accurate and up-to-date records of patient interactions and outcomes to facilitate informed decision-making.

Responsibilities Include:

  1. Manage pre-authorizations for patients requiring specialized medical services.
  2. Collaborate with healthcare providers and client relations to ensure seamless communication and care coordination.
  3. Analyze data to identify trends and areas for improvement in patient outcomes and resource utilization.
  4. Develop and implement strategies to mitigate risks associated with patient care and authorization processes.
  5. Ensure compliance with regulatory requirements and organizational policies.

Qualifications:

  • Bachelor's degree in a relevant field
  • 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 analytical and problem-solving skills
  • Ability to work effectively in a fast-paced environment
  • Knowledge of healthcare regulations and compliance requirements strongly advantageous
  • Proficiency in using case management software, ICD-10 codes, and procedure codes strongly advantageous


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