Key details

Job Highlight

Requirements

Experience

Appropriate experience preferably at hospital level, alternatively at a medical scheme or in a clinical environment.

Competencies (knowledge/skills): Ability to link patient diagnosis (ICD10 Coding) with procedure codes.

Knowledge of the UPFS and ability to perform clinical audits of patient accounts.

Knowledge of the Medical Scheme Act 131 of 1998 and relevant PMB Regulations.

Excellent verbal and written communication skills.

Excellent interpersonal skills and the ability to act independently, objectively and with confidence and collaboratively as part of the healthcare team.

Computer literate (Microsoft Office/Teams).

Ability to work under pressure, handle a high work volume and meet strict deadlines.

Strong critical thinking and problem-solving abilities.

Duties

Ensure that pre-admission and pre-authorisation information is accurate and in accordance with hospital and funder procedures.

Manage and implement Case Management policies, protocols and procedures timeously.

Provide training and workshops when required.

Liaise with internal and external stakeholders such as Funders and Managed care organisations with regards to treatment of patient, MHC policies, protocols, optimal fund utilisation, clinical information, diagnostic and procedural coding.

Provide complete and accurate clinical updates and discharge information to Funders.

Conduct clinical audits of patients’ accounts and ensure clinical auditing of the account controllers are accurate.

Ensure accurate, specific and comprehensive clinical coding.

Complete queries/requests of the Medical Scheme follow-up section timeously. -Queries will include drafting of motivational letters where possible, obtaining authorisation, concurrent review of patient clinical information, i.e. length of stay, level of care, clinical coding and PMB.

When handling or investigating a debtor query, ensure the account is accurately billed.

Manage the workflow and supervise personnel of the Case Management department.

Participate in interdisciplinary team meetings to optimize patient care.

Provide estimations for all patient classifications.

Provide Case management statistics on a weekly / monthly basis.

How to apply

Tip: Many government posts require a completed Z83 form. Download it above and follow the guide.

Notes

No payment of any kind is required when applying for this post.

This post does not form part of any Occupation Specific Dispensation.

Shortlisted candidates may be subjected to a practical test.