Case Manager (Health Group) – Johannesburg, Gauteng 47 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)
