A vacancy exists for a Case Manager General based at Life Fourways Hospital, reporting to the Patient Services Manager. The successful candidate will be responsible for the financial and clinical administrative risks pertaining to patients and units. This person will be responsible to effectively communicate and deliver an uncompromising quality of service to all internal and external customers by ensuring that all clinical updates and coding are of the highest standard.
Critical OutputsEnsuring the maximization of revenue by:
Ensuring accuracy of codingEnsuring the correct application and interpretation of RSRT'sParticipating in meetings and reporting losses to RSRT team and recommending corrective actionsMonitoring insurance verification and workflow processesEnsuring effective management of quality outputs by:
Performing quality walkabouts and implementing corrective measuresImplementing and monitoring quality improvement programmesAdhering to patient services escalation processes in order to achieve QMS targetsMonitoring Q-evaluator scores and implementing corrective measuresInvestigating internal and external stakeholder complaintsEnsuring the adherence to customer service standardsEnsuring operational excellence by:
Monitoring submission of accurate accounts to fundersUpdating length of stay and level of care to medical aidsReleasing care risk targets and submission within two days of dischargeEnsuring compliance to LHC policies and managing authorisations and claim submissions, rejections and delaysEnsuring governance and risk management by monitoring and adhering to patient services policies and proceduresEnsuring compliance to service level agreements with internal and external stakeholdersEnsuring all billing checks are closed by the relevant function areasEnsuring effective management of relationships with internal/external stakeholders by:
Building and maintaining relationships with internal stakeholdersProviding feedback and information on concerns or issues raised by internal stakeholdersProviding and facilitating training regarding RSRT contracts to the relevant internal stakeholdersEnsuring effective communication with external stakeholdersManaging escalated concerns from Case Managers with external stakeholdersEscalating doctor non-compliance in terms of RSRT framework to RSRT meetingsCarrying out Clinical coding in accordance with CPT and ICD requirements and as per LHC standardsMaintaining patients' clinical status in accordance with funder approval requirements for the duration of hospitalisation; keeping patients informed and managing the entire hospital stay's financial riskProviding complete and accurate updates and discharge informationMaintaining accurate accounts of all admissionsImproving on short payments and lossesTimeous electronic submission of accountsHandling patient files in accordance with hospital proceduresEnsuring the adherence of hospital staff to funder rules and coding proceduresMust be willing to work flexi hours including weekends and public holidays as required operationally by the businessKeeping well informed on legislation pertaining to funders and related Health Care mattersRequirementsDiploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational coursesCurrent SANC registrationKnowledge of hospital patient services and case management processesKnowledge and understanding of CPT & ICD codingKnowledge of Funder contracts, scheme rules, exclusions and benefitsUnderstanding of private hospital industry and practicesComputer proficiencyCompetenciesProblem-solving, analysis and judgementResilienceEngaging diversityVerbal & written communication skillsProfessional and technical proficiencyBuilding relationshipsCustomer responsivenessOrganisational awarenessInfluencing skillsAction orientationExcellence orientationEthical behaviourEmail: ******
Closing date: Wednesday, October 9, 2024
Internal applicants - Before making an application, you are requested to discuss your application with your line manager. External candidates will also be considered.
Life Healthcare is an Equal Opportunity Employer.
Thank you for your interest in this opportunity. Kindly note that only shortlisted candidates will be contacted. Applicants who have not been contacted within two weeks of the closing date of this advert should consider their application as unsuccessful.
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