Jobs at Melomed Private Hospitals

Description

• Final assessment of all patient files to ensure that all stock, service related charges are recorded on account as per actual usage and is billed according to the NHN guidelines and Melomed Policies and Procedures.
• Final assessment of all patient files to ensure that all documentation is in file.
• Assessment and monitoring of long stay patients for accuracy. Timeous final billing of claims to maintain the target of final billing.
• Submission of WCA, COID claims to respective funders.
• Timeous Escalation of cases within turnaround time where LOS, LOC and Codes are not approved to maintain the target of accurate final billing of files within 3 days.
• Application of clinical knowledge in reviewing ICD and CPT coding of patient accounts.
• Ensure that all claims are submitted timeously via the Medikredit Panel.
• Timeous escalation of any Medikredit Rejections and maintain a high level of integrity of the Medikredit Panel.
• Follow up with external service providers and stakeholders on outstanding documentation required for the accurate final billing of files to maintain the target of final billing.
• Timeous resolution of queries from Credit Control emanating from final billed files to maintain targets and objectives.
• Following up and resolving queries from internal and external customers and stakeholders.
• Daily and weekly reports. Adherence to deadlines.
• Administrative tasks.
• Adhoc and administrative duties as requested by line manager.
• Liaising with patients for queries. General filing.
• Ability to stay abreast of industry trends and knowledge.
• Keep up to date and compliance with Melomed’s Policies and Procedures.
• Maintain and sustain working key internal and external relationships.

Requirements

Core Competencies:

Education:

• Grade 12 or equivalent NQF4 qualification
• Proficiency in Computer Literacy
• Certificate in ICD 10 and CPT Coding
• A Nursing qualification will be preferred

Experience:

• Minimum 3 years relevant experience in a multidisciplinary hospital

Knowledge & Skills:

• Computer Literacy Strong Administrative Skills Knowledge of Fixed Fees, per Diems and Alternate Reimbursement Models
• Knowledge of applicable statutory acts such as Consumer Protection Act; PMB; POPIA, etc.
• Excellent communication skills (written and spoken)

Role Summary:

• The Final Biller will be responsible for accurate assessment and final submission of files for accurate accounting with Scale of Benefits and National Hospital Network Billings and Tariff guidelines while maintaining the target of final billing

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Description

• Obtain authorizations for after-hours admissions
• Daily capture of all clinical information such as Authorizations Number, Length of Stay (LOS) and Level of
• Care (LOC)
• Daily monitor and review of Confirmations
• Reports Validation of all authorizations and memberships
• Validation and confirmation of membership, authorization, benefits and limits on Theatre Slate and timeous distribution thereof to all stakeholders
• Follow up on all baby registrations to ensure that dependents are registered within 7 working days of admission.
• Timeous and effective communication of Funder responses and requirements to all stakeholders.
• Serve as a liaison between Case Managers, Medical Funders, and various stakeholders.
• Assist with forwarding supporting documentation such as but not limited to X Rays, MRI’s, Pathology results, Scope Reports, Letters of Motivation (LOM), Caesarian Form, etc. to Funders
• Timeous follow up and escalation to Funders on unapproved Authorizations, LOS and LOC to ensure that the target is maintained.
• Effective & timeous communication of financial risks, such as non-declaration, benefit limits on Medical Aids, low option medical aid plans, declined authorizations, requests for letters of motivations to internal and external stakeholders. Liaise with patients on declined authorizations, co-payments, benefit limits, etc.
• Assist with timeous escalation of cases within turnaround time for LOS, LOC and Codes that are not approved to maintain the target of accurate final billing and submission.
• Follow up with external service providers and stakeholders on outstanding documentation required by Funders for the accurate final billing and submission of files to maintain targets.
• Following up and resolving queries to ensure that the targets are maintained.
• Application of clinical knowledge in reviewing ICD and CPT coding of patient accounts.
• Adherence to deadlines.
• Administrative tasks.
• Adhoc and administrative duties as requested by line Manager.
• Ability to stay abreast of industry trends and knowledge.
• Keep up to date and compliance with Melomed’s Policies and Procedures.
• Maintain and sustain working key internal and external relationships

Requirements

Core Competencies:

Education:

• Grade 12 or equivalent NQF4 qualification
• Certificate in ICD 10 and CPT Coding (Preferred)

Experience:

• Minimum 3 years relevant experience in a multidisciplinary hospital
• Experience in National Hospitals Network (NHN) Billings would be preferred

Knowledge & Skills:

• Computer Literacy
• Strong Administrative Skills
• Knowledge Alternate Reimbursement Models
• Knowledge of applicable statutory acts such as Consumer Protection Act; PMB; POPIA, etc.
• Excellent communication skills (written and spoken)