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Healthcare Operations Specialist
3 weeks ago
Job Overview
">Hire Resolve is seeking a skilled and detail-oriented Hospital Case Manager to join their healthcare team. The successful candidate will be responsible for coordinating patient care, ensuring accurate medical coding, and optimizing hospital reimbursements while maintaining high-quality patient care standards.
Key Responsibilities:
- Patient Case Management: Assess and manage patient cases to ensure efficient hospital care and appropriate medical aid approvals.
- Authorization & Pre-Approvals: Obtain authorization for hospital admissions and liaise with medical aids to ensure timely approvals.
- Clinical Coding: Ensure accurate ICD-10 and CPT coding for billing purposes.
- Utilization Review: Monitor length of stay, treatment plans, and resource utilization to optimize hospital efficiency.
- Collaboration: Work closely with doctors, nurses, and medical aid schemes to facilitate smooth patient care processes.
- Compliance & Reporting: Maintain documentation and ensure compliance with medical aid policies, hospital protocols, and legal standards.
- Patient Advocacy: Support patients by explaining medical aid benefits and assisting with any coverage issues.
Requirements:
- Qualification: Diploma/Degree in Nursing or a related healthcare field.
- Clinical Coding Certification (advantageous).
- Experience: At least 23 years of experience in hospital case management or a similar role.
- Knowledge of ICD-10 & CPT Coding.
- Strong understanding of medical aid processes and hospital billing systems.
- Excellent communication and negotiation skills.
- Ability to work in a fast-paced hospital environment.
