Case Manager - Johannesburg at Clinix Health Group (Pty) Ltd

Minimum Requirements:

• Relevant Nursing qualification.
• CM or Billings Clerk with ICD training and anatomy and physiology course certification.
• IDC and CPO coding.
• 3-5 years’ experience as a hospital case manager.

Minimum work experience:

• Liaise with Receptionist for authorisations.
• Ensure compliance to case management procedures, standards and protocols.
• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols.
• Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital.
• Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, DOL, etc.).
• Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility.
• Consult daily with all relevant health care providers with regards to patient treatment.
• Ensure the maintenance of patients’ clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalisation.
• Ensure the correct categorisation and management of different patient accounts to facilitate reimbursement by Funder.
• Ensure accurate and timeous finalisation of cases to facilitate reimbursement by Funders.
• Minimise financial risk by the effective management of patient hospitalisation.
• Follow the established and approved escalation processes in the event of a decline of payment by Funder.
• Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed).