Billings and Accounts Manager

Melomed Private Hospitals SA; South Africa; On-site; ZAR 400 000 - 600 000; Full time

Job summary

A leading healthcare provider in South Africa is seeking an experienced professional to manage the Case Management and Billing teams. The role involves providing guidance, ensuring compliance with healthcare regulations, and managing financial operations to enhance efficiency. Ideal candidates will have a background in healthcare management, strong analytical skills, and experience in team leadership. Join a dynamic environment where your contributions will directly impact patient care and operational success.

Qualifications

• Proven experience in a leadership role within a healthcare environment.
• Strong understanding of healthcare regulations and billing processes.
• Ability to analyze data and implement improvement strategies.

Responsibilities

• Provide effective leadership and direction to team members.
• Ensure adherence to operational protocols and compliance.
• Manage financial risks and billing operations.

Skills

Leadership

Team Management

Financial Management

Compliance Knowledge

Analytical Skills

Education

Degree in Healthcare Management or related field

Job description

• Provide effective leadership by offering guidance, support, and direction to the Case Management and Billings team members, ensuring the department operates efficiently.
• Provide training and development opportunities for Case management and Billings team members on relevant operating policies, protocols, systems, procedures, standards, and techniques.
• Ensure the recruitment of experienced & suitably qualified team members to fill approved vacancies in alignment with HR recruitment processes.
• Ensure effective onboarding and integration of new staff members into the team.
• Facilitate regular team meetings to review progress, address concerns, share updates, and discuss billing planning and implementation.
• Provide feedback to team members regarding their performance and implement corrective actions as necessary.
• Ensure team alignment with corporate values and culture.
• Manage the financial risk and working capital of the hospital by ensuring accurate and timely case management updates and billing of patient records.
• Ensure that Case management and Billing operations are conducted in accordance with departmental protocols and comply with healthcare.
• Implement strategic goals and objectives to enhance operational efficiency and ensure the achievement of key targets.
• Analyse case management / billing errors and develop quality improvement plans.
• Monitor and manage the in-patients report for long-stay, private, and insured patients, identifying any associated risks and ensuring that all tariff charges are accurate and up to date.
• Ensure that the Case Managers adhere to their agreed TAT by updating in-patient admissions and attending to high-value in-patient cases daily.
• Audit coding on claims and verify that co-morbidities have been captured.
• Audit clinical data submitted to the medical funder / aid / institute to ensure accuracy and compliance.
• Ensure adherence to the high-cost medication processes.
• Monitor and report on variances in Fixed Fees and Managed Health Care.
• Manage cancelled / requests for reversals of claims for changes to LOC, LOS, CPT or ICD codes effectively.
• Assist staff members with the escalation of claims, queries, billing, LOM requests, and to resolve complex issues.
• Understand and remain updated with current coding and billing regulations, compliance requirements, and scheme rules changes.
• Ensure the timely submission of all reports to the relevant stakeholders.
• Monitor and review the following reports daily to ensure accuracy and completeness :

Ward Report - Ensure all patients are allocated to a Case Manager and that their information is updated accordingly.

Non-Release Report - Ensure all discharge folders are received.

Medikredit Control Panel Report - Ensure all claims are accurate and submitted accordingly.

Theatre Slate Report – Monitor and ensure timeous updates and identify risks.

• Liaise with the Credit Control Department regarding claims, billing, and related matters, ensuring that all queries are addressed and actioned by the relevant staff members.
• Ensure POPI compliance and accurate record keeping of patient records
• Consult with HODs, Hospital Management, Head Office Management, and Specialists to review departmental procedures and operational effectiveness.