Admin Manager

2 weeks ago


Cape Town, Western Cape, South Africa Immploy Recruitment Full time
Manage the Admin Department and processes with regards to non-releases

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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