CM or Billings Clerk with ICD training and anatomy and physiology course certification
IDC and CPO coding
Must have worked previously as a Registered Nurse
3-5 years’ experience as a hospital case manager
The main purpose of this position:
To plan, coordinate and execute case management work at hospital level
The incumbent utilities clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care
Duties & Responsibilities:
Liaise with Receptionist for authorisations
Ensure compliance to case management procedures, standards and protocols
Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols
Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital.
Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, DOL, etc.)
Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility
Consult daily with all relevant health care providers with regards to patient treatment
Ensure the maintenance of patients’ clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalisation
Ensure the correct categorisation and management of different patient accounts to facilitate reimbursement by Funder
Ensure accurate and timeous finalisation of cases to facilitate reimbursement by Funders
Minimise financial risk by the effective management of patient hospitalisation
Follow the established and approved escalation processes in the event of a decline of payment by Funder
Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed)
Should you meet the above requirements, we urge you to apply by forwarding your CV along with any supporting documents to tracy@glass-house.co.za
