CASE ADMINISTRATOR - CASE MANAGEMENT

Joint Medical Holdings Group; Durban; On-site; ZAR 240,000 - 320,000; Full time

Job summary

Joint Medical Holdings Group in Durban seeks a Case Administrator to provide administrative and financial support across the case management lifecycle from admission to discharge. You will handle medical-aid information, authorisations, updates and documentation to support billing and cash flow.

The role requires experience in healthcare administration, familiarity with authorisations and funding requirements, and strong MS Office skills.

Qualifications

• Grade 12/Matric with relevant healthcare admin exposure.
• Experience in private hospital, medical-aid or billing preferred.
• Knowledge of medical-aid processes and funding requirements.
• Basic hospital billing and account submission understanding.
• Computer literacy including MS Office; familiarity with HIS advantageous.

Responsibilities

• Obtain and verify medical-aid membership, benefits and pre-authorizations.
• Follow up outstanding authorizations, extensions and funding requirements.
• Assist with daily patient-in-progress reporting and ensure required documentation is obtained.
• Follow up outstanding clinical and administrative information for finalization of accounts.
• Ensure patient accounts are complete and identify delays or rejections.
• Liaise with Billing, Bill Audit and Case Management on requirements and queries.
• Monitor medical-aid claim rejections and queries; gather information for resolution.
• Monitor patients in hospital, including long-stay/high-value cases, with current funding info.
• Maintain accurate case-management records and timely data capture.
• Adhere to hospital policies, scheme requirements, confidentiality, and timelines.

Skills

Medical administration

Billing

Case management

Authorisations knowledge

Confidentiality practices

Education

Grade 12 / Matric

Tools

Microsoft Office

Hospital information systems

Job description

PURPOSE OF POSITION

The Case Administrator provides administrative and financial support to the Case Management function, ensuring patient cases are accurately managed from admission through to discharge and account submission. The role ensures medical-aid information, authorisations, clinical updates and account documentation are followed up timeously, contributing to accurate billing, reduced claim rejections, improved cash flow and effective debtor management.

KEY PERFORMANCE AREAS

• Obtain and verify medical-aid membership, benefits and required pre-authorizations.
• Follow up outstanding authorizations, extensions and funding requirements.
• Assist with daily patient-in-progress reporting and ensure required documentation is obtained.
• Follow up outstanding clinical and administrative information required for account finalization.
• Ensure patient accounts are complete and identify information that may result in claim rejection or payment delays.
• Liaise with Billing, Bill Audit and Case Management regarding outstanding account requirements and billing queries.
• Monitor medical-aid claim rejections and queries and obtain information required for resolution.
• Monitor patients who remain in hospital, including long‑stay and high‑value cases, and ensure funding information is current.
• Maintain accurate case‑management records and reports and ensure information is captured timeously.
• Adhere to hospital policies, medical‑scheme requirements, confidentiality standards and agreed turnaround times.

MINIMUM REQUIREMENTS

• Grade 12 / Matric.
• Previous experience in a private hospital, medical‑aid, healthcare administration, billing or case‑management environment.
• Knowledge of medical‑aid processes and hospital patient administration.
• Understanding of authorisations, medical‑aid benefits and funding requirements.
• Basic understanding of hospital billing and account submission processes.
• Computer literacy, including Microsoft Office.
• Experience with hospital information systems would be advantageous.

NB: Only short‑listed candidates will be contacted.
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If unsuccessful, your personal information is securely destroyed and is not retained by the company.
Preference will be given to employees from the designated group in line with the Employment Equity Act.