Case Manager

5 days ago


Pretoria, South Africa Armstrong Appointments Full time

The position reports to the Patient Admin Manager and will be responsible for the following performance areas:

- Responsible for the case management with the hospital
- Interactions with medical schemes to ensure authorizations are provided timeously
- Verification of clinical coding
- Provides support for the management of alternate fee structures
- Liaison with doctors on funder requirements when necessary
- Continuous performance and quality management
- Interpretation and implementation of scheme benefit rules
- Maintains client service principles to ensure client expectations are met

Qualifications:
Bachelor’s Degree in nursing

**Experience**:

- Registered with the South African Nursing Council as a Professional Nurse or Registered Nurse
- Experience in a managed healthcare environment
- Knowledge of coding and coding regulations
- Intermediate knowledge of Microsoft Office Suite
- Knowledge of the rules and regulations regarding medical aid schemes
- Knowledge of Trifour system will be an advantage
- Independent problem-solving and decision-making kills.
- Good accuracy and attention to detail skills in order to maintain high standards of work output
- Ability to function well within a team.
- Understand the interrelationships between business processes
- Maintains a customer-focus mindset that acknowledges the value of the client.


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