About the position
THE JOB AT A GLANCE
As the Pensions Medical Case Auditor (PMCA), you will be responsible for effectively and efficiently rendering medical support to internal and external stakeholders.
WHAT WILL YOU DO?
- Monitoring of Hospital Admissions weekly and liaison with Case Managers.
- Give feedback to Case Managers and other Colleagues of Pensioners admitted in Hospitals and include for hospital utilisation management.
- Authorization of Pensioners Hospital admissions, Chronic Medications and Sundries, prosthetic repairs and replacement
- Adjudicate requests for subsequent care and refer to RMA doctor as necessary.
- Assess and adjudicate medical service provider reports and advise on invoices submitted and captured when requested.
- Visit medical service providers and hospitals to address Pensioners related issues
- Organize and attend scheduled clinics.
- Organize transport for SCI acute admissions, uro reviews and taxi fares for prosthetic pensioners.
- Visit existing high risk/cost and new DRG 1 pensioners as per PMP schedule.
- Organizing uro reviews and capture the uro report.
- Organize prosthetic review clinic and load report on CC2.
- Assist to obtain death certificate and Notification of Death (if available) for deceased pensioners and autopsy reports if available.
- Assist with medical walk-in office clients.
- Capture Medical Reports via scanning in respect of pensioners, chronic medication, and subsequent care and specific medical reports requested.
- Assist with education of pensioners on entitlements.
- Updating DOCR with hospital pensioner admissions and discharges for DRG 1 to 3.
- Weekly/Monthly report of Pensioner URO reviews, home visits and prosthetic reviews and other interventions.
- Manage visa and passport expiry documents of SCI pensioners in Hospital.
- Managing and control of medical expenses as per yearly plan
- Follow up, from RMA system generated reports, high-cost claims based on type of injury and estimated costs.
WHAT YOU'LL BRING TO THE TABLE?
- Nursing diploma /degree or Medical/Clinical Associate Degree
- 3 years nursing experience as a professional nurse or medical/clinical experience as a Clinical associate
- Case management experience within the insurance industry
- ICD10 coding knowledge
- CPT codes
- Valid Driver's License
- Registration with Nursing Council or relevant Health Professional Council
- Attention to detail
- Building Customer Loyalty
- Contributing to Team Success
- Managing Work (includes Time Management)
- Stress Tolerance
- Decision Making
- Confidentiality
- Credibility
- Friendly
- Initiative
- Integrity
- Budget management (advantageous)
Turnaround time
The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of managers. Kindly note that should you not receive a response within 21 days please consider your application unsuccessful.
Our Commitment to transformation:
In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under-represented designated groups.
Desired Skills:
- ICD10 coding
- CPT codes
- Budget Management
Desired Work Experience:
Desired Qualification Level & Accreditations:
- Diploma
- Health Professions Council of South Africa
- South African Nursing Council
About The Employer:
WHAT WILL YOU GET IN RETURN?
This is an exciting opportunity within the Rand Mutual Assurance team, offering exposure to an interesting combination of technical and business issues. This is a great time to join RMA as we look to grow the Life business and develop our actuarial team.
We offer great opportunities for personal and professional development in a stable company that's 130 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration.
Employer & Job Benefits:
- Group Life Assurance
- Medical Aid
