The incumbent will be responsible for the liaison between the patient and medical aids in order to secure payment for the hospital.
Duties & Responsibilities
Ensuring efficient management of a very complexed department
All IR management to be handled efficiently
Liaise network of internal and external stakeholders to ensure that managed care of patients is maintained
Monitor and control costs for Managed Care Organization patients
Confirm length of stay for all Managed Care Organizations patients
Ensure correct coding is applied for all Managed Care Organization patients
Assisting Clinicians and all Allied facilities with account queries
Complying with governance and risk management requirements by ensuring to patient services policies and procedures
Ensuring correct application of ARM agreements on patient accounts
Building and maintaining relationships with internal stakeholders
Ensuring effective management of real time clinical updates, including requests, responses, rejections and submissions
Ensuring effective Communication regarding funder requirements / responses to attending clinicians and patients where necessary compliance with industry standards
Meeting targets of monthly cash collections / maintaining of DNYB days on 5 days and below
Desired Experience & Qualification
B Degree Nursing Qualification or equivalent NQF level 6
3 years patient care experience and Case management will be an advantage
Previous ICU / HC Case management experience will be an advantage
Understanding of clinical coding, funder rules – advance coding an advantage
Nursing policies and procedures
SAP Experience preferably
Must be available to work overtime where required
Advanced Computer Literacy will be an advantage
Good communication skills
Good customer responsiveness
Good time management skills
Need to be able to work under pressure
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
