Case Manager – Hospital Group (Kwa-Zulu Natal) 4 views
Job Overview
Main Purpose of Job:
Ensure that the complete Case Management function is performed on a daily basis.
Application of policies for the operation within the Hospital Industry.
Ensuring adherence to all relevant statutes, statutory bodies, rules and regulations, disciplinary code, and staff employee manuals.
Requirements:
- A valid Grade 12 or Matric Equivalent Certificate
- Extensive case management background with ICU/ High Care experience
- Computer literacy essential
- Strong Administration skills
- Knowledge of Medical Aid Policies & Procedures
- Above average interpersonal and Communication Skills
- Absolute compliance with Confidentiality Policies & Procedures
Duties & Responsibilities:
- Check confirmations for L.O.S and L.O.C relative to each patient.
- Assess patient clinical reports for communication to Medical Aids.
- Process updates with Medical Aid for each patient.
- Intermediate/ Advanced competency of ICD 10 and CPT coding.
- Check all ICD, CPT Coding, and authorization numbers.
- Handle communication and queries with Medical Aid Case Managers.
- Assist Patients/Doctors with patients requiring step down facilities.
- Liaising with Doctors, Nursing Staff and Patients.
- Liaising with the Debtors Department regarding any queries.
- Release and submit claims timeously to medical aid via Medikredit.
- Release and submit accounts timeously.
- Constantly monitoring patient status.
- Constantly liaising with Medical Aids updating patient status.
- Effective communication with Patients, Doctors, Nursing Staff, Medical Aids etc.
- Ensure adequate record keeping.
- General administration duties.
- Ensure weekly case management queries are carried out
