Clinical Operations Specialist
2 days ago
To plan, coordinate and execute case management work for RAF Business in the CHG Facilities. The incumbent utilises clinical and RAF knowledge in managing RAF Business in the facilities to minimise financial risk and ensure accurate billing through comprehensive accurate coding and classification of RAF available products offered in the facilities, Authorization of these products to ensure that they will be fully reimbursed.
Key Responsibilities:- Collaborate with the fund to ensure that the patient/claimant have access to quality healthcare services from both Acute and Rehabilitation to achieve good clinical outcomes and reintegration back to the society.
- Establish a framework in enhancing service delivery to patients with due attention to the Fund`s financial obligation and payment processes.
- Conduct site case management through visits to different CHG facilities and Government facilities where CHG has signed MOA with and share clinical updates with the fund.
- Obtaining approval of care based on the Fund`s treatment protocols and an appropriate referral system for specialized management.
- Establish working groups with sufficient representation from the Fund and facilities to enable good clinical governance.
Diploma/ Degree in General Nursing or Business-Related qualification. 3-5 years experience as RAF Case manager/Claims Adjudication Unit. Knowledge of ICD-10 and CPT coding. Knowledge of RAF Industry
Compensation:Estimated salary: $60,000 - $80,000 per annum depending on qualifications and experience.
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