About Company
Cimas Medical Aid Society is a leading healthcare solutions provider in Zimbabwe, dedicated to enhancing the well-being of individuals and communities. With a legacy spanning decades, Cimas has consistently delivered comprehensive medical aid and health-related services, making quality healthcare accessible. We are committed to innovation, integrity, and fostering a culture of care, not just for our members, but also for our valued employees. Our mission is to be the partner of choice for health and wellness, providing peace of mind through reliable, member-centric services. We believe in empowering our teams to make a significant difference in the lives of those we serve, supporting professional growth and work-life balance.
Job Description
Cimas Medical Aid Society is seeking a highly meticulous and dedicated Remote Healthcare Authorization Processing Specialist to join our dynamic team. This pivotal role ensures that our members receive timely access to necessary medical treatments and services by efficiently managing the prior authorization process. As a Remote Healthcare Authorization Processing Specialist, you will play a crucial part in navigating the complexities of healthcare regulations and insurance requirements from the comfort of your home office, while being an integral part of our Redcliff-focused operations in the Midlands Province. Your expertise will directly impact patient care, reducing administrative burdens on healthcare providers and ensuring seamless service delivery for our members.
This position requires an individual with exceptional organizational skills, a deep understanding of medical terminology, and an unwavering commitment to accuracy. You will be responsible for obtaining, verifying, and tracking healthcare service authorizations, collaborating closely with healthcare providers, and communicating effectively with internal teams to resolve any authorization-related issues. The ideal candidate will thrive in a remote work environment, demonstrating strong self-motivation, independent problem-solving abilities, and a proactive approach to workload management. Join Cimas and contribute to a mission that genuinely makes a difference in people’s health and lives, all while enjoying the flexibility and autonomy of a remote role.
Key Responsibilities
- Process pre-authorization requests for medical services, procedures, and medications in strict adherence to company policies and regulatory guidelines.
- Verify member eligibility and benefits, ensuring all necessary documentation is complete and accurate before submission.
- Communicate effectively with healthcare providers, clinics, and hospitals to obtain clinical information required for authorization decisions.
- Monitor the status of submitted authorizations, following up promptly to ensure timely approvals and escalating complex cases as needed.
- Document all communication and authorization activities meticulously in the designated electronic health records (EHR) or internal systems.
- Address and resolve authorization denials or appeals by gathering additional information and working with clinical teams.
- Maintain up-to-date knowledge of medical terminology, CPT/ICD-10 codes, and healthcare insurance regulations.
- Ensure strict compliance with all relevant data privacy laws, including HIPAA and local regulations.
- Provide exceptional customer service to members and providers regarding authorization inquiries.
- Participate in ongoing training and professional development to enhance skills and knowledge.
Required Skills
- Minimum of 2 years of experience in healthcare administration, medical billing, or prior authorization.
- Proficiency in medical terminology, CPT, ICD-10 coding, and healthcare insurance processes.
- Exceptional attention to detail and accuracy in data entry and documentation.
- Strong verbal and written communication skills.
- Demonstrated ability to work independently and manage time effectively in a remote setting.
- Proficiency with office software (MS Office Suite) and experience with EHR/EMR systems.
- Strong analytical and problem-solving abilities.
Preferred Qualifications
- Associate's or Bachelor's degree in Healthcare Administration, Medical Office Management, or a related field.
- Certification in Medical Assisting, Medical Billing and Coding, or similar.
- Familiarity with Cimas-specific systems or similar large-scale medical aid platforms.
- Previous experience working in a remote or virtual team environment.
Perks & Benefits
- Competitive salary and performance-based incentives.
- Comprehensive Cimas Medical Aid coverage.
- Paid time off and public holidays.
- Opportunities for professional development and career growth.
- Supportive remote work environment with necessary tools and resources.
- Contribution to a leading national healthcare provider.
How to Apply
Interested candidates who meet the above criteria are encouraged to apply by clicking on the application link below. Please ensure your resume highlights your relevant experience and skills for this remote role. We look forward to reviewing your application and potentially welcoming you to the Cimas family.