Case Manager

Duties & Responsibilities: Ensure all the relevant details on the hospital billing system are updated and accurate 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 Ensure correct and timeous finalization of cases to facilitate reimbursements from funders of claims Billing of patients with the day tariff and ward stock issued. Ensuring all billing checks are closed by the relevant function areas Ensure all the ward stock is billed, discharge the patient, and submit the claim. Supply all details regarding the patients history to Clinical partners Monitor and control costs for managed care organization patients Confirm length of stay for all managed care organizations patients Assist with final authorization of managed care patient files Ensure correct coding for all managed care organization patients Assist with the transfer of patients to other facilities Liaise network of internal and external stakeholders to ensure that managed care of patients is maintained Keep up to date with evolving policies and procedures Requirements: Relevant Nursing Qualification or equivalent NQF level 6 At least 3 years in the managed health care industry or private hospital Case Management in hospital and patient care experience Knowledge of ICD-10 & CPT coding, medical scheme rules Ability to liaise with external parties clinicians and members. Computer literate - MS Office suite, i.e. Word, Excel.

Location: Western Cape, ZA

Posted Date: 12/17/2024