The successfulcandidate will be responsible for managing the financial and clinical risks ofthe patient in a general ward by ensuring accurate coding, clinical updatesand accounts submissions of patient hospitalization to achieve strategicobjectives.Critical Outputs? Ensuring the maximisation of revenue by? Ensuring accuracy of coding? Ensuring the correct application and interpretation of RSRT's? Participating in meetings and reporting losses to RSRT team andrecommend corrective actions? Monitoring insurance verification and workflow processes? Ensuring effective management of quality outputs by? Performing quality walkabouts and implement corrective measures? Implementing and monitoring quality improvement programmes? Adhering to patient services escalation processes in order to achieveQMS targets? Monitoring Q-evaluator scores and implementing corrective measures? Investigating internal and external stakeholder complaints? Ensuring the adherence to customer service standards? Ensuring operational excellence by? Monitoring submission of accurate accounts to funders? Updating length of stay and level of care to medical aids? Releasing care risk targets and submission within two days of discharge? Ensuring the compliance to LHC policies and managing authorisationsand claim submissions, rejections and delays? Ensuring governance and risk management by monitoring and adheringto patient services policies and procedures? Ensuring compliance to service level agreements with internal andexternal stakeholders? Ensuring all billing checks are closed by the relevant function areas? Ensuring effective management of relationships with internal/externalstakeholders by? Building and maintaining relationships with internal stakeholders? Providing feedback and information on concerns or issues raised byinternal stakeholders? Providing and facilitating training regarding RSRT contracts to therelevant internal stakeholders? Ensuring effective communication with external stakeholders? Managing escalated concerns from Care Risk Managers with externalstakeholders? Escalating doctor non-compliance in terms of RSRT framework to RSRTmeetingsRequirements? Nursing Qualification, Professional Nurse with at least three to fiveyears' experience? Current SANC registration? Knowledge of hospital patient services and case managementprocesses? Knowledge and understanding of CPT & ICD coding? Knowledge of Funder contracts, scheme rules, exclusions and benefits? Understanding of private hospital industry and practices? Computer proficiency
