Assistant Case Manager at Gauteng Department of Health

Requirements :

• Appropriate Diploma/Degree/Enrolled Nursing Certificate in a Health-Related Field.
• 0-2 years’ experience in a clinical field. Experience in case management will be an added advantage. Registration with SANC or HPCSA for 2025/2026.
• Must be Computer Literate.Skills/Competence/Knowledge: Knowledge of National Health Act, Medical Schemes Act, Occupational Health, and Safety Act.
• PFMA, RAF Act, COIDA, Patient's Right Charter, Batho Pele Principles, UPFS policy, ICD 10 coding, classification of patients, NHI and PAIA management policy. Must have good verbal and report writing communication skills. Good telephone etiquette and interpersonal relations skills.

Duties :

• Report directly to the Case Manager. Responsible for confirmation/authorisation of medical aid patients telephonically/online for all admissions and outpatient consultations, of all private and externally funded patients within 36 hours of admission/accessing medical care within the facility. Ensure accurate ICD 10 coding and Prescribed Minimum Benefit (PMB) application to minimize claim rejections.
• Visit wards daily to check/identify private, foreign and medical aid patients in all business units. Responsible for completing charge sheet to charge all services rendered to patients and assist Billing Clerks to raise correct claim rand amount towards revenue collection. Assist to bill medical aid patients. Audit all claims for ICD 10 coding and UPFS accuracy before being submitted for payment to funders to minimise rejections.
• Coordination and assistance with ICD 10 Coding training. Keeping monthly statistics on hospital ICD 10 coding compliance to ensure reporting. Attend training and workshops as and when required and/or requested to do so. Assist with compilation of clinical updates to the medical schemes and ensure approved Length of Stay. Perform any reasonable tasks within the directorate as may be required. personnel performance and review thereof.