ADMIN MANAGER

Melomed Private Hospitals SA; South Africa; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A healthcare organization in South Africa seeks a candidate to manage the Admin Department, including billing oversight and staff training. Key responsibilities involve ensuring compliance with medical coding regulations and conducting routine meetings. Ideal candidates should have strong leadership skills and experience in medical administration.

Responsibilities

• Manage the Admin Department and processes regarding non-releases.
• Manage Credit Control queries.
• Ensure accurate ICD 10 and CPT Coding.
• Conduct routine staff meetings regarding billing.
• Oversee and streamline the billing processes.

Job description

Responsibilities

• Manage the Admin Department and processes with regards to non-releases
• Manage the Credit Control queries
• Manage Case Manager updates and escalations for Medical Aids
• Ensure accurate ICD 10 and CPT Coding
• Analysis of Billing errors
• Managing Fixed Fee Contracts with Medical Aids
• Management of staff
• Daily and Monthly reporting to Hospital Manager and Head Office regarding Admin stats
• Month end finalisation of files
• Private patients’ quotations, Financial Risk Management and daily banking
• Auditing of Hospital folder greater than 10K
• Auditing coding on claims and checking if co-morbidities have been captured
• Auditing of clinical data submitted to the Medical funder / aid / institute
• Ensuring that the high cost medication process has been followed
• Responsible for the security and accuracy of the patient records
• Liaise with the relevant stakeholders regarding claims, billings etc. and ensure that all claims / queries have been actioned by the relevant staff members within the Department
• Oversee and streamlinethe billing processes
• Plan and implement quality assurance for all billing and case management processes
• Conduct routine staff meetings regarding billing planning and implementations
• Assist in standardising the methods in which work will be accomplished
• Ensure that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol and follow Melomed healthcare regulations, guidelines and requirements, review departmental procedures and evaluate the effectiveness of personnel
• Understand and remain updated with current coding and billing regulations, compliance requirements and scheme rules changes / requirements
• Provide, oversee, and / or coordinate the provision of training for new and existing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques
• Checking of daily reports
• Ward report – ensure all patients are allocated to a Case Manager and updated accordingly
• Non–Release - ensure all discharge folders are received
• Medikredit Control Panel - ensure all claims are accurate and submitted accordingly
• Checking daily Theatre slates
• Follow up on daily, weekly and monthly queries
• Assist staff members with escalation of claims, queries, billings and LOM requests