ADMIN MANAGER

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

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