Clinical Coder/Case Manager - Cape Town at Faircape Group

Position Overview:

The Clinical Coder/Case Manager at Faircape Health Tokai is responsible for precise coding of diagnoses, procedures, and treatments while adhering to coding standards. Additionally, they provide case management services to rehabilitation patients. This role demands meticulous attention to detail, strong communication skills, and collaborative work with healthcare professionals, patients, and medical funders.

Are you a detail-oriented individual with a strong commitment to accuracy and a passion for healthcare, then apply now

Duties include but are not limited to:

Clinical Coding:

• Accurately code and classify diagnoses, procedures, and treatments using the ICD and CPT coding systems.
• Ensure the completeness, accuracy, and integrity of clinical coding data in compliance with relevant regulations and standards.
• Collaborate with healthcare professionals to gather necessary information for coding and documentation improvement.
• Conduct regular audits to monitor coding quality and identify areas for improvement.
• Ensure correct ICD 10 coding – coding to remain ethical and accurate at all times. 
• To code admission diagnosis and ensure all relevant comorbidity are captured on Healthware

Case Management:

• Provide case management services to patients, coordinating their care plans and ensuring timely and appropriate interventions.
• Facilitate an efficient authorisation process.
• Monitor patient progress, evaluate outcomes, and act as a liaison between healthcare providers/MDT, and medical finders to ensure proper documentation and billing practices.
• Collaborate with the interdisciplinary team to ensure seamless coordination of care.
• Communicate coding and case management updates to relevant stakeholders.
• Follow up calls with medical aids for outstanding authorisations

Requirements
Qualifications - Relevant tertiary degree is advantageous

Experience and Knowledge -  

• Strong administrative skills; 
• Experience in hospital administration / medical environment 
• Experience of medical aid administration procedures and hospital case management (acute or subacute), experience in a managed healthcare environment as a strong advantage. 
• Comprehensive knowledge of funder contracts, funder rules, co-payments and exclusions, solid knowledge of the rules and regulations regarding medical aid schemes, knowledge of ICD10, CPT 4 codes as well as BHF tariff codes.
• Knowledge of ICD10, CPT 4 codes as well as BHF tariff codes

Skills and Attributes

• Good understanding of the private healthcare industry and its challenges
• Excellent decision-making skills
• Ability to multitask and work efficiently under pressure
• Excellent attention to detail
• Ethical integrity
• Strong interpersonal skills and professional communication.
• Computer proficiency
• Professional and focused
• Well presented and professional.
• Business Acumen