Case Administrator - Isipingo

Joint Medical Holdings Ltd.; KwaZulu-Natal; On-site; ZAR 180,000 - 240,000; Full time

Job summary

Joint Medical Holdings Ltd. is seeking a Case Administrator - Isipingo to manage communications between hospital and medical aid schemes. The role focuses on monitoring gaps, ensuring coding accuracy, and coordinating with case managers.

The ideal candidate will have ICD/CPT coding qualifications, Delta 9 experience, and at least 1 year of customer service and hospital admissions experience to support patient services and auditing processes.

Qualifications

• Grade 12 qualification is required.
• Must be computer literate and able to use standard office software.
• Experience liaising with medical aids, doctors and patients is essential.
• Hospital environment experience is advantageous.
• Strong attention to detail and auditing ability are required.

Responsibilities

• Track correspondences between hospital and medical aid schemes and monitor gaps.
• Review discharge files for length of stay, level of care and coding accuracy.
• Verify codes with medical aid funds for inpatient coverage.
• Assist with ICD coding, theatre time and level of care communications to doctors’ rooms.
• Follow up on outstanding DSM and progress reports as directed by the Hospital Case Manager.
• Escalate closed files and provide summaries to ensure updates are reflected in the system.

Job description

About the job Case Administrator - Isipingo

The Case Administrator is responsible for tracking of correspondences between Hospital and Medical Aid Schemes. Identify and monitor gaps, risk and assist with the implementation of correct actions agreed with management.

KEY PERFORMANCE AREAS

• Track discharge files, review and ensure length of stay, level of care and coding approving
• Review and ensure High-cost items are approved by the fund.
• Call Medical Aids on the In patients to verify Codes submitted are covered by the fund
• Check DSP listing/Procedure Co-payment listing, alert case manager of the amount member needs to pay
• Assist with Forwarding ICD Coding /Theatre Time and Level of care to doctors' rooms
• Follow up on Outstanding DSM and Progress reports required by the Hospital Case Manager
• Files that are closed by the Hospital Case Manager – Refers to Escalation Matrix, assist with sending to the relevant email addresses.
• Assist with Auditing Bulletin and Provides a summary to Patient Services Manager on Outstanding updates.

COMPETENCIES (The following will be advantageous)

MINIMUM REQUIREMENTS

(Educational Qualifications & Experience)

• Must have a Grade 12 qualification
• Must be computer literate
• Preferably have Delta 9 experience
• ICD and CPT coding qualifications
• Billing / Auditing experience will be advantageous.
• Experience in a multidisciplinary hospital environment.
• Must have experience in liaising with medical aids, doctors, and patients
• Must have at Least 1 year customer services experience.
• Must have least 1 year Hospital Admissions or Confirmations experience.