Case Administrator - Isipingo at Joint Medical Holdings

• The Case Administrator is responsible for tracking of correspondences between Hospital and Medical Aid Schemes. Identify and monitor gaps, risk and assist with the implementation of correct actions agreed with management.

KEY PERFORMANCE AREAS

• Track discharge files, review and ensure length of stay, level of care and coding approving
• Review and ensure High-cost items are approved by the fund.
• Call Medical Aids on the In patients to verify Codes submitted are covered by the fund
• Check DSP listing/Procedure Co-payment listing, alert case manager of the amount member needs to pay
• Assist with Forwarding ICD Coding /Theatre Time and Level of care to doctors' rooms
• Follow up on Outstanding DSM and Progress reports required by the Hospital Case Manager
• Files that are closed by the Hospital Case Manager – Refers to Escalation Matrix, assist with sending to the relevant email addresses.
• Assist with Auditing Bulletin and Provides a summary to Patient Services Manager on Outstanding updates.

COMPETENCIES (The following will be advantageous)

MINIMUM REQUIREMENTS

(Educational Qualifications & Experience)

• Must have a Grade 12 qualification
• Must be computer literate
• Preferably have Delta 9 experience
• ICD and CPT coding qualifications
• Billing / Auditing experience will be advantageous.
• Experience in a multidisciplinary hospital environment.
• Must have experience in liaising with medical aids, doctors, and patients
• Must have at Least 1 year customer services experience.
• Must have least 1 year Hospital Admissions or Confirmations experience.