JOB SPECIFICATION
Job Title: Administration and Authorisations Manager – Pet & Health Care (Insurance industry).
Reports To: Financial Manager / Department Manager
Occupation Level: Middle Management
Based in: In office, Sandton.
Reference No: PM-A 0924
Job Summary:
The Administration and Authorisations Manager is responsible for overseeing the daily administrative operations and managing the insurance processes for client transactions for approvals of procedures. This role involves liaising with suppliers (Health care facilities and practices), addressing clients queries and concerns, ensuring compliance with health regulations, streamlining administrative processes, and working closely with clinical teams to support client/patient care. The manager also plays a critical role managing the administration team, enhancing operational efficiency and ensuring timely client/patient access to necessary services.
Duties & Responsibilities:
Authorisation Management:
Oversee the entire insurance authorisation process for hospital services, including surgeries, treatments, and diagnostic procedures.
Ensure all necessary documentation, including medical records, is submitted accurately and in a timely manner.
Ensuring productivity and execution of authorisations are done timeously.
Resolve issues with denied claims, claim queries or delayed authorisations.
Administrative Operations:
Supervise administrative staff responsible for managing patient/client registrations, billing, and other clerical functions.
Implement efficient administrative workflows and ensure proper record-keeping.
Collaborate with clinical departments to ensure smooth coordination between administrative and clinical functions.
Monitor compliance with health and safety regulations, data protection laws, and health care policies.
Financial Oversight:
Collaborate with the finance department to track and monitor administration and authorisations for payment processing.
Ensure accurate billing and timely invoicing based on authorized services.
Oversee cost estimates for claims and review concerns related to the product policies for approval of claims.
Team Leadership:
Lead and develop a team of administrative and authorisation staff, providing training and mentoring as needed.
Set performance goals for the team and ensure they meet the established standards.
Conduct performance reviews and provide ongoing feedback for team improvement.
Compliance & Reporting:
Ensure adherence to all legal, regulatory, and accreditation standards related to hospital administration and insurance practices.
Prepare regular reports on authorisations, denials, and pending claims for senior management.
Maintain records of all authorizations, including dates, approvals, denials, and appeals.
Key Performance Indicators (KPIs):
Authorisation Approval Rate:
Percentage of authorization requests approved on the first submission.
Average time taken to secure approvals from insurance companies.
Claims Denial Resolution:
Rate of resolved denied claims.
Time taken to appeal, and resolve denied claims.
Client Satisfaction:
Patient feedback on administrative processes, particularly regarding billing and insurance communication.
Timeliness in addressing patient concerns and questions.
Operational Efficiency:
Reduction in administrative processing times for admissions and discharges.
Efficiency in coordinating patient authorizations with clinical schedules.
Team Performance:
Achievement of team-based goals (e.g., meeting deadlines, accuracy of submissions).
Staff retention and satisfaction within the administrative team.
Compliance Adherence:
Zero incidents of non-compliance with health, safety, and insurance regulations.
Number of audits passed with minimal issues.
Key requirements of the role:
Education:
Bachelor's degree in business financial administration (BCom) and/or Bachelor of science (BSc) or a related field, would be advantageous.
Medical workplace experience working within a hospital or medical center for 2-3 years.
Qualified Nurse with 3-5 years' experience within the Health Service would be advantageous.
Additional certifications in healthcare management or insurance billing are a plus.
Experience:
5+ years of experience in healthcare administration, including at least 2 years in an insurance authorisation or billing role.
Proven experience managing a team in a healthcare setting.
In-depth knowledge of health insurance policies, reimbursement processes, and authorization procedures.
Familiarity with hospital administrative processes and insurance claim systems.
Proficient in office management software and Microsoft Office Suite.
Strong organizational and leadership skills.
Excellent communication and interpersonal abilities.
Ability to multitask and prioritize effectively in a fast-paced environment.
Problem-solving skills and attention to detail.
Highly administrative and accurate in execution of tasks.
Proven experience as an Admin Manager or in a similar role, including motivating of staff and ensuring the team is highly productive.
Skills & Competencies:
Strong understanding of healthcare regulations and standards.
Excellent communication and interpersonal skills for patient interaction and insurance negotiations.
Leadership and team management capabilities.
Proficiency with healthcare management software (e.g., EHR systems, billing software).
Strong organizational and problem-solving skills.
Ability to work under pressure and meet deadlines, within a high-performance driven environment.
Personal Attributes:
Attention to detail and accuracy in managing paperwork.
Empathy and patience when dealing with clients claims and their concerns.
Adaptability in a fast-paced and evolving healthcare environment.
Ethical and compliant approach to administrative duties.
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