Admin Manager
2 weeks ago
Manage the Credit Control queries
Manage Case Manager updates and escalations for Medical Aids
Ensure accurate ICD 10 and CPT Coding
Analysis of Billing errors
Managing Fixed Fee Contracts with Medical Aids
Daily and Monthly reporting to the Hospital Manager and Head Office regarding Admin stats
Month end finalisation of files
Private patients' quotations, Financial Risk Management and daily banking
Auditing of Hospital folder greater than 10K
Auditing coding on claims and checking if co-morbidities have been captured
Auditing of clinical data submitted to the Medical funder / aid / institute
Ensuring that the high cost medication process has been followed
Responsible for the security and accuracy of the patient records
Liaise with the relevant stakeholders regarding claims, billings etc. and ensure that all claims / queries have been actioned by the relevant staff members within the Department
Oversee and streamline the billing processes
Plan and implement quality assurance for all billing and case management processes
Conduct routine staff meetings regarding billing planning and implementations
Assist in standardising the methods in which work will be accomplished
Ensure that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol and follow Melomed healthcare regulations, guidelines, and requirements and review departmental procedures and evaluate the effectiveness of personnel
Keep up to date with carrier rule changes and distribute the information within the Group
Understand and remain updated with current coding and billing regulations, compliance requirements and scheme rules changes / requirements
Provide, oversee, and/or coordinate the provision of training for new and existing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques
Checking of daily reports
Ward report - ensure all patients are allocated to a Case Manager and updated accordingly
Non-Release - ensure all discharge folders are received
Medikredit Control Panel - ensure all claims are accurate and submitted accordingly
Checking daily Theatre slates
Follow up on daily, weekly and monthly queries
Assist staff members with escalation of claims, queries, billings and LOM requests
Grade 12 or equivalent
An applicable tertiary qualification will be an advantage - Finance Diploma
A minimum of - 5 years Management or Supervisory experience
In depth knowledge of ICD 10 and CPT Coding
Thorough understanding of CPT and ICD 10 coding standard s
In-depth knowledge and understanding of Private Hospital Billings guidelines / NHN billings guidelines
General accounting knowledge and financial skills
The ability to work well under pressure
Excellent attention to detail
The ability to function independently
Excellent time management skills
Computer literacy is essential
Between - 5 Years
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