Business Unit: Discovery Health
Function: Risk Management
Date: 10 Sep 2024
Discovery – Health | Health Strategic Risk Management
Risk Specialist
About Discovery
Discovery's core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.
Job Purpose
The position exists within the Corporate Contracting team where the key purpose is managing risk in a range of areas such as hospitals, pathology, and radiology related costs and influencing business strategy for all administered medical schemes through various risk mitigating strategies and projects. Develop, manage, and co-ordinate projects and initiatives related to pathology spend.
Areas of Responsibility
Proactively engage with analysts in understanding risks to the schemes.
Identify risk trends in terms of hospital spend and development of sustainable solutions.
Regular engagement with hospitals, pathology, and radiology groups funder relations on related initiatives as well as internal stakeholder management.
Product or benefit redesign through the R&D process and provider contracting.
Management and maintenance of hospitals, pathology, and radiology benefits, input on escalated cases and review of benefits/protocols.
Implementation and monitoring of new products/projects and pathology tariffs.
Development of hospital DSP status with alternative reimbursement models (ARMs) and monitoring.
Ability to provide support for the broader SRM and Operational team, work closely with systems and functional teams to ensure that all requirements are aligned with the business plan, to ensure timely delivery of projects.
Producing regular monitoring reports, as well as detailed investigation outcomes.
Qualification Requirement
Clinical qualification.
Relevant Business Bachelor's Degree (Advantageous).
Essential Experience
Risk Management skill or experience.
3-5 years managed healthcare industry experience.
Basic ICD-10 and CCSA coding and other coding schemas (RPL and UPFS) knowledge and experience.
Advantageous Experience
Good knowledge of Discovery Health Pathology products and protocols.
Technical Skills or Knowledge
Strong analytical skills, strong Excel, and PowerPoint skills. Proven problem-solving skills. Good project management skills.
Effective communication skills (verbal & written).
Knowledge of Discovery Health systems (internal only).
EMPLOYMENT EQUITY The Company's approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.
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