The successful
candidate will be responsible for managing the financial and clinical risks of
the patient in a general ward by ensuring accurate coding, clinical updates
and accounts submissions of patient hospitalization to achieve strategic
objectives.
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 and
recommend 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 achieve
QMS 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 authorisations
and claim submissions, rejections and delays
? Ensuring governance and risk management by monitoring and adhering
to patient services policies and procedures
? Ensuring compliance to service level agreements with internal and
external stakeholders
? Ensuring all billing checks are closed by the relevant function areas
? Ensuring effective management of relationships with internal/external
stakeholders by
? Building and maintaining relationships with internal stakeholders
? Providing feedback and information on concerns or issues raised by
internal stakeholders
? Providing and facilitating training regarding RSRT contracts to the
relevant internal stakeholders
? Ensuring effective communication with external stakeholders
? Managing escalated concerns from Care Risk Managers with external
stakeholders
? Escalating doctor non-compliance in terms of RSRT framework to RSRT
meetings
Requirements
? Nursing Qualification, Professional Nurse with at least three to five
years' experience
? Current SANC registration
? Knowledge of hospital patient services and case management
processes
? 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
