Case Manager

VENCORP PLACEMENTS • Other • Garden Route, South Africa • 1d ago

Duties & Responsibilities:

Ensure all the relevant details on the hospital billing system are updated and accurate
Plan, coordinate and execute clinical coding in accordance with relevant Client standards and protocols
Ensure accurate, appropriate, and complete diagnostic and procedural coding of all patient records in the hospital
Ensure correct and timeous finalization of cases to facilitate reimbursements from funders of claims
Billing of patients with the day tariff and ward stock issued.
Ensuring all billing checks are closed by the relevant function areas
Ensure all the ward stock is billed, discharge the patient, and submit the claim.
Supply all details regarding the patients history to Clinical partners
Monitor and control costs for managed care organization patients
Confirm length of stay for all managed care organizations patients
Assist with final authorization of managed care patient files
Ensure correct coding for all managed care organization patients
Assist with the transfer of patients to other facilities
Liaise network of internal and external stakeholders to ensure that managed care of patients is maintained
Keep up to date with evolving policies and procedures

Requirements:

Relevant Nursing Qualification or equivalent NQF level 6
At least 3 years in the managed health care industry or private hospital
Case Management in hospital and patient care experience
Knowledge of ICD-10 & CPT coding, medical scheme rules
Ability to liaise with external parties clinicians and members.
Computer literate - MS Office suite, i.e. Word, Excel.

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