Case Manager (Health Group) – Johannesburg, Gauteng 167 views

Job Overview

Requirements:

 

  • Relevant Nursing qualification
  • CM or Billings Clerk with ICD training and anatomy and physiology course certification
  • IDC and CPO coding
  • 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 Client 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)
Apply for this job

Contact Us

Unit 3 Sunningdale Suites
12 Wild Wood Close
Sunningdale
Cape Town
Send an email
+27 21 554 5309 / +27 21 200 6629