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Group Patient Services Manager
3 weeks ago
To take responsibility for overseeing the revenue cycle value chain from a Group perspective which includes identifying improvement opportunities to optimise billing to maximise revenue. This includes the reduction of the Groups financial risk by ensuring compliance to Group policies and procedures including contractual arrangements with Medical Schemes/ funders.
***Job Requirements**:
- Degree in Nursing (Registered Nurse).
- Diploma in Theatre/ Critical Care Nursing Science or experience.
- Computer training in advanced ICD-10 and CPT Coding is a must.
- Microsoft PowerPoint /Word /Excel/ Teams Proficiency.
- Financial acumen advantageous.
- Minimum 5 years’ experience as Patient Services manager / Patient Admin manager will be advantageous.
- Experience in the healthcare industry is a must.
- SAP Knowledge.
- Strong leadership and interpersonal skills.
**Critical Outputs**:
- Chair the Revenue Cycle Management Committee.
- Implement funder contracts pertaining to the revenue cycle and monitor compliance.
- Identify training needs for the revenue cycle department and provide or facilitate training.
- Support the Funder Relations Management team.
- Attend operations meetings with funders and provide feedback to teams.
- Ensure that new tariffs and billing rules are loaded accurately on the SAP system.
- Ensure the addition of new CPT/ICD coding, are loaded/updated appropriately where applicable.
- Assist in implementing SAP and MediKredit Modules at hospital level.
- Monitor the EDI report from MediKredit to ensure all queries have been resolved and all cases are EOC (end of case).
- Draw reports from SAP system on discharged files and select sample files for auditing.
- Support the Group Pharmacy Manager in the creation of material sets (together with relevant stakeholders) on SAP to ensure optimization of billing of materials (consumables).
- Review services (together with relevant stakeholders) on SAP to ensure optimization of billings of services (equipment).
- Review revenue (RPPD) and debtors’ days by analyzing reports received from Group Finance in terms of budget v actual revenue - address improvement opportunities with hospitals.
- Identify high Rand value cases weekly and ensure that these are final billed as soon as possible after discharge.
- Support Group Nursing services manager to enforce and monitor the use of Mobile Billing.
- Ensure the delivery of market leading quality care across the Clinix Health Group service offering.
- Continuous assessment, improvement implementation of processes as GAPS are identified in business.
- Increase and support the current electronic messaging environment.
- Ensure compliance to group working procedures and assist the business units to develop unit specific services areas.
- Report monthly/quarterly on systems/process performance, identify trends.
- Develop credible relationships with key leaders and customers in the business and across funders.
- Implement a group strategy on short-payment management to improve cash flow.
- Manage financial risk by:
- DRG profit analysis and reporting.
- Engagement with funders counterparts regarding disputes with regards to revenue cycle contractual agreements.
- Analyse data trends relating to rejections and short payments etc.
- Verification of clinical coding as per policies and procedures.
- Preparing and ensuring sound audit compliances to achieve optimum business ethics.
- Participating and developing action plans within the revenue management team.
- Create online training tools to empower business on management of short payments.
- Implement effective controls to ensure accurate billing by:
- Driving the accurate and business billing process to ensure Patient Services metric targets are achieved.
