Clinical Coder/Case Manager at Faircape Group

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

Specific Requirements:

• Clear health record
• Clear criminal record
• Clear credit record
• Contactable references