Active Jobs 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).

go to method of application »

Minimum Qualifications and experience:

• Nursing Diploma
• 2-3 years’ experience in Billings environment
• Advanced Computer Literacy
• SAP will be an advantage.

Minimum Duties:

• Perform Billings Auditing duties in accordance with the Clinix Health Groups standard and procedure.
• Adhere to the principles and standards of patient advocacy according to the Clinix Health Groups
• Review and analyze reports as a management tool, to identify negative trends and implement corrective action.
• Audit patient files as per Company requirements (and standards) and in accordance with the Company contracts with Medical Schemes
• Perform End of Case on the approved system
• Ensure the accurate maintenance of supplier invoices.
• Efficient management of Billing processes by Specific to private patients, final bill invoices on the SAP system as ‘paper’ claim and forward patient files to the collections department for further management.
• Adhere to reporting standards by analysing information and reports by identifying trends, discrepancies and inconsistencies for decision making.