Clinical Coding Specialist

2 weeks ago


Pietermaritzburg, KwaZulu-Natal, South Africa Immploy Full time
Job Title: Case Manager

Immploy is seeking a highly skilled Case Manager to join our team. As a Case Manager, you will play a critical role in ensuring the smooth operation of our hospital's case management processes.

Key Responsibilities:
  • Clinical Coding: You will be responsible for carrying out clinical coding in accordance with CPT and ICD requirements, ensuring accuracy and compliance.
  • Pre-Admission and Pre-Authorisation: You will ensure that pre-admission and pre-authorisation information is accurate and in accordance with hospital and funder procedures.
  • Patient Clinical Status: You will maintain patients' clinical status in accordance with funder approval requirements for the duration of hospitalization, keeping patients informed and managing the entire hospital stay's financial risk.
  • Discharge Information: You will provide complete and accurate updates and discharge information of all accounts.
  • Account Maintenance: You will maintain accurate accounts of all admissions.
  • Patient Files: You will handle patient files in accordance with hospital procedures, ensuring timely electronic submission of accounts and follow-up on short payments arising from case management-related issues.
  • Funder Rules and Coding Procedures: You will ensure the adherence of hospital staff to funder rules and coding procedures.
  • Legislation and Healthcare Matters: You will keep well-informed on legislation pertaining to funders and related healthcare matters.
Minimum Requirements:
  • SANC Registration: You must be registered as a Registered Nurse or an Enrolled Nurse with the South African Nursing Council.
  • Case Management Experience: You must have at least 5 years of experience as a case manager, either at hospital level or with the Medical Schemes (preferably case management experience at hospital level).
  • Medical Aid Administration: You must have experience with Medical Aid administration procedures, including ICD10, CPT 4 Procedure Codes, and Per Diems.
  • Hospital Billing and Tariffs: Knowledge of hospital billing and tariffs, as well as Hospital Information System, will be advantageous.
  • Stakeholder Relations: You must be able to build good relations with various internal and external stakeholders.


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