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Case Manager x 2
(Internal & external)
Purpose of the job
Minimizing the financial risk to the hospital by securing payment from the funders: By providing accurate clinical information to the funders with the aim to secure full and final settlement of the patient accounts on submission.
Key Responsibilities Include:
- Conducting daily ward rounds and ensuring the accurate and complete collection of clinical data from the patient files / nursing staff.
- The timeous and accurate updating of all clinical information to justify length of stay and level of care to medical schemes.
- Communicating of funder requirements to attending specialists.
- Accurate and complete coding of all patient accounts.
- High level bill auditing of all patient files.
- Discharge notification to all funders with updated LOS and Level of Care confirmed with the funder, before submission of accounts.
- Releasing / submission of accounts to funders and follow up of EDI rejections, etc.
- Compliance to the Patient Administration Services policies and procedures.
- Building and maintaining relationships with internal and external stakeholders.
Qualifications & Experience:
- B Degree Nursing Qualification or equivalent NQF level 6.
- Proof of Coding Courses Completed.
- At least 3 years case management experience in the private hospital industry.
- Previous specialized unit case management experience.
- Outstanding knowledge of clinical coding & funder rules.
- Specialised Unit Experience important. (Adult ICU, NNICU, Cardiac ICU).
- Trained experience will be an advantage.
- Advanced computer literacy is not negotiable.
Other Requirements
- Well-developed interpersonal and organizational skills:
- Ability to work well under pressure unsupervised
- Good time management skills.
- Good communication skills.
Interested candidates who meet the above criteria are requested to email their CV together with an application covering letter and recently certified copies of qualifications, or hand in at the Human Resources office on 3rd floor. Closing date for the above position is Tuesday 20 August 2024 at 16h00