At Busamed, we are dedicated to providing exceptional healthcare services, and we are always looking for passionate and talented individuals to join our team. Whether you're a seasoned professional or just starting your career in healthcare, Busamed offers a dynamic and supportive work environment where you can grow and make a meaningful impact.
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The Group Case Manager will be responsible for the liaison between the Busamed hospitals and medical aids in order to secure payment for all hospital accounts.
Requirements
Grade 12 or equivalent NQF level 4 qualification
Diploma in General Nursing Qualification
ICD & CPT Coding certification will be required
Intermediate computer skill (Excel and Word)
Work Experience
Previous Case Management experience will be required
Excellent Interpersonal and communication skills
NOTE this position involves some travel between the Busamed hospitals. Position is KZN based
Knowledge
To engage and train all case managers in group on all aspects in their IPD
Ensure all the relevant details on Hospital Billing System are updated and are accurate
Supply all details regarding patients’ history to Clinical partners
Monitor and control costs for Managed Care Organisation patients
Assist at group level to confirm length of stay for all Managed Care Organisations patient’s stay in dispute
Assist with final authorisation of Managed Care patient files
Assist all hospital case managers with correct coding for all Managed Care Organisation patients
To upskill case managers by proving relevant coding courses, mentoring and coaching of case managers
Review case management policies for the group
To engage MCO and other funds for cases that is not within TAT for approval
To raise matters and communicate with funders on challenges arising in the case management space at Busamed hospitals
Liaise networking of internal and external stakeholders to ensure that managed care of patients is maintained
Actively participate as a member of a team to achieve goals
Active involvement in own professional development to maintain a satisfactory level of skill and knowledge
Work effectively and co-operatively with others to establish and maintain good working relationships
To engage medical aids on account rejections relating to ARM contracts, LOS/LOC disputes, to final resolution of claims
Manage the Group Debtors Age rejections with the Hospital Case Management Teams
To provide hospitals with case manager support with clinical updates when required
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