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Case Manager

Clinix Health Group (Pty) Ltd

Johannesburg

On-site

ZAR 350,000 - 600,000

Full time

20 days ago

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Job summary

A leading health care provider seeks a mid-senior Case Manager to oversee hospital case management tasks. The ideal candidate must have a diploma in nursing and substantial experience in managing patient care and billing. Strong attention to detail, effective communication skills, and proficiency in coding standards are essential. This position plays a critical role in minimizing financial risks and ensuring compliance with health care standards.

Qualifications

  • Minimum 5 years’ experience as a hospital Case Manager.
  • Technical knowledge of ICD-10 and CPT coding required.
  • Understanding of private health care operations.

Responsibilities

  • Plan, coordinate, and execute case management work.
  • Ensure accurate billing through comprehensive coding of patient care.
  • Communicate with funders to manage patient treatment effectively.

Skills

Attention to detail
Communication
Investigation skills

Education

Diploma in Nursing
Advanced Certification in Intermediate Coding

Job description

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To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care.

Minimum Requirements

  • Diploma in Nursing
  • 5 years’ experience as a hospital Case Manager
  • Technical Knowledge of ICD-10 and CPT Coding
  • Advance Certification in Intermediate coding - Preferred
  • Knowledge of private health care operations
  • Attention to detail and ability to confirm accuracy of files

Minimum Work Experience

  • Ensure compliance to case management procedures, standards and protocols.
  • Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols.
  • Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, DOL, etc.)
  • Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilisation, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and any required changes in patient treatment.
  • Investigate and understand Funder, Doctors, Nurses and Patient needs to enable delivery of a quality service.
  • Ensure timeous resolution of stakeholder queries and complaints and take ownership of case management and reimbursement related issues.
  • Escalate potential risks that may lead to increased costs or financial losses.
  • Maintain accurate records of patient care and timeously submit to funders to ensure the organisation is appropriately reimbursed for all services rendered.
  • Liaise with the Billing department with regards to conversion of medical aid patients to cash patients.
  • Adhere to statutory standards, policies and procedures within the business unit to ensure compliance at all times and take remedial action where necessary.

Seniority level
  • Seniority level
    Mid-Senior level
Employment type
  • Employment type
    Full-time
Job function
  • Job function
    Other
  • Industries
    Hospitals and Health Care

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