The successful
candidate will be responsible for managing the financial and clinical risks of
the patient in a general ward by ensuring accurate coding, clinical updates
and accounts submissions of patient hospitalization to achieve strategic
objectives.
Critical Outputs
Ensuring the maximisation of revenue by
Ensuring accuracy of coding
Ensuring the correct application and interpretation of RSRT’s
Participating in meetings and reporting losses to RSRT team and
recommend corrective actions
Monitoring insurance verification and workflow processes
Ensuring effective management of quality outputs by
Performing quality walkabouts and implement corrective measures
Implementing and monitoring quality improvement programmes
Adhering to patient services escalation processes in order to achieve
QMS targets
Monitoring Q-evaluator scores and implementing corrective measures
Investigating internal and external stakeholder complaints
Ensuring the adherence to customer service standards
Ensuring operational excellence by
Monitoring submission of accurate accounts to funders
Updating length of stay and level of care to medical aids
Releasing care risk targets and submission within two days of discharge
Ensuring the compliance to LHC policies and managing authorisations
and claim submissions, rejections and delays
Ensuring governance and risk management by monitoring and adhering
to patient services policies and procedures
Ensuring compliance to service level agreements with internal and
external stakeholders
Ensuring all billing checks are closed by the relevant function areas
Ensuring effective management of relationships with internal/external
stakeholders by
Building and maintaining relationships with internal stakeholders
Providing feedback and information on concerns or issues raised by
internal stakeholders
Providing and facilitating training regarding RSRT contracts to the
relevant internal stakeholders
Ensuring effective communication with external stakeholders
Managing escalated concerns from Care Risk Managers with external
stakeholders
Escalating doctor non-compliance in terms of RSRT framework to RSRT
meetings
Requirements
Nursing Qualification, Professional Nurse with at least three to five
years’ experience
Current SANC registration
Knowledge of hospital patient services and case management
processes
Knowledge and understanding of CPT & ICD coding
Knowledge of Funder contracts, scheme rules, exclusions and benefits
Understanding of private hospital industry and practices
Computer proficiency
