Senior Case Manager

2 weeks ago

Rondebosch, South Africa RONDEBOSCH MEDICAL CENTRE Full time

Description

Critical Outputs

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

Carry out clinical coding in accordance with CPT/CCSA and ICD requirements.

Daily ward rounds for effective clinical update communication and timeous follow up with medical aids.

Maintain patients’ clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients informed and managing the entire hospital stays’ financial risk.

Provide complete and accurate updates and discharge information of all accounts.

Maintaining accurate accounts of all admissions

Handle patient files in accordance with hospital procedures.

Timeous electronic submission of accounts and follow up on short payments arising from case management related issues.

Ensure the adherence of hospital staff to funder rules and coding procedures.

Keep well informed on legislation pertaining to funders and related Health Care matters.

**Requirements**:
Nursing: SANC registration RN or EN, with Case Management qualification/experience

Nonclinical case managers with Case Management qualification/experience

High school matric certificate.

3 - 5 years’ experience in clinical coding, private hospital case management and Medical Aid administration procedures.

Knowledge of hospital billing, funder contracts and tariffs would be an advantage.

Have sound computer literacy skills and working knowledge of MS office, word and excel.

Excellent communication skills and the ability to form and build strong relationships
& partnerships with internal & external stakeholders.

Excellent negotiation skills & the ability to interact with tact and diplomacy.

Competencies
- Collaboration/ Relationship Building
- Report writing
- Analytical thinking
- Problem-solving, analysis and judgement
- Resilience
- Engaging diversity
- Verbal & written communication and presentation skills
- Negotiation
- Influencing
- Strategic agility
- Planning
- Customer responsiveness
- Project management
- Organisational awareness
- Excellence and quality orientation
- Ethical behaviour
- Technical and professional knowledge
- Adaptability
- Attention to detail
- Builds effective teams
- Change agent
- Coaching
- Conflict resolution
- Innovation
- Decision making
- Organising
- Quantitative analysis

Ability to Commute:

- Rondebosch, Western Cape (required)

Ability to Relocate:

- Rondebosch, Western Cape: Relocate before starting work (required)

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