Case Manager

Job Summary:

To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care.

Minimum Qualifications and Experience:

• Diploma in Nursing
• 5 years’ experience as a hospital Case Manager
• Technical Knowledge of ICD-10 and CPT Coding
• Advance Certification in Intermediate coding - Preferred
• Knowledge of private health care operations
• Attention to detail and ability to confirm accuracy of files

Minimum Job Requirements:

• Ensure compliance to case management procedures, standards and protocols.
• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols.
• 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 any required changes in patient treatment.
• Investigate and understand Funder, Doctors, Nurses and Patient needs to enable delivery of a quality service.
• Ensure timeous resolution of stakeholder queries and complaints and take ownership of case management and reimbursement related issues.
• Escalate potential risks that may lead to increased costs or financial losses.
• Maintain accurate records of patient care and timeously submit to funders to ensure the organisation is appropriately reimbursed for all services rendered.
• Liaise with the Billing department with regards to conversion of medical aid patients to cash patients.
• Adhere to statutory standards, policies and procedures within the business unit to ensure compliance at all times and take remedial action where necessary.