NB: is a Three (3) years Fixed-Term Contract position<\/p>\n
Purpose of the job: The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.<\/p>\n
Key Performance Areas<\/p>\n
\tMedical Management.
\n\tConduct medical assessment and compile injury assessment reports.
\n\tConduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
\n\tIncorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the RAF and \/ or any that is considered reasonable.
\n\tPre authorise submitted claims aligned to RAF clinical guidelines including the RAF formularory, treatment protocols and related tarrifs.
\n\tEscalation of complex cases for multi disciplinary review and adjudication.
\n\tParticipate in the consultations process on the implementation of medical claims processes.<\/p>\n
Exception Handling.<\/p>\n
\tEnsure the implementation and maintenance of a formal exception handling process within the medical management.
\n\tMaintain the documentation and regular updating of the exception handling process.
\n\tMaintain the implementation an unusual occurrence procedures.<\/p>\n
Reporting.<\/p>\n
\tTrack and report against set objectives and targets.
\n\tReport on emerging risks.
\n\tProvide ad hoc reports on process improvement initiatives.
\n\tProduce documents, briefing papers, reports and presentations.<\/p>\n
Stakeholder Management<\/p>\n
\tDeal with\/and respond to correspondence.
\n\tMaintain healthy relationships with all stakeholders.
\n\tFollow up and resolve all queries, following up and making recommendations on which corrective actions are appropriate.
\n\tFollow up and feedback to all stakeholders to keep them updated on the status of a query.
\n\tRespond to queries within the predefined turnaround times.<\/p>\n
Qualifications<\/p>\n
\tBachelor\u2019s Degree\/Advanced Diploma in Health Sciences \/Medical related qualification.
\n\tRegistration with HPCSA\/SANCA.<\/p>\n
Experience<\/p>\n
\tRelevant 3 years\u2019 experience in a Medical related environment.
\n\tTechnical and behavioral competencies required
\n\tClaims management process\/ processes and systems.
\n\tMedical product management
\n\tMedical bill reviewing
\n\tMedical case management
\n\tComplex problem identification, solving and decision making
\n\tCustomer value proposition
\n\tStrong clinical analytical capabilities
\n\tKnowledge of motor vehicle accident legislation
\n\tPlanning, Organising and Coordinating
\n\tPersonal Mastery
\n\tJudgement and Decision Making<\/p>\n
Ethics and Values<\/p>\n
\tClient Service Orientation<\/p>\n
go to method of application \u00bb<\/p>\n
Apply via company website ( http:\/\/www.raf.co.za ) or<\/p>\n
<\/p>\n","protected":false},"author":2,"featured_media":0,"template":"","meta":{"_promoted":"","_job_location":"","_application":"","_company_name":"Road Accident Fund","_company_website":"http:\/\/www.raf.co.za","_company_tagline":"The Road Accident Fund is a state insurer established by statute, it provides insurance cover to all drivers of motor vehicles in South Africa in respect of liability incurred or damage caused as a result of a traffic collision. Liability incurred in relation to property damage (such as damage to ve... read morehicles, buildings, vehicle contents) is excluded from cover.","_company_twitter":"","_company_video":"","_filled":0,"_featured":0,"_remote_position":0,"_job_salary":"","_job_salary_currency":"","_job_salary_unit":""},"job_listing_region":[11],"job-types":[18],"class_list":["post-22241","job_listing","type-job_listing","status-expired","hentry","job_listing_region-gauteng","job-type-contract"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-listings\/22241","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-listings"}],"about":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/types\/job_listing"}],"author":[{"embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/users\/2"}],"wp:attachment":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/media?parent=22241"}],"wp:term":[{"taxonomy":"job_listing_region","embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job_listing_region?post=22241"},{"taxonomy":"job_listing_type","embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-types?post=22241"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}