Case Manager

Clinix Health Group (Pty) Ltd; Noordwes; On-site; ZAR 420,000 - 620,000; Full time

Job summary

Clinix Health Group (Pty) Ltd seeks an experienced hospital case manager to plan, coordinate and execute clinical coding at hospital level. You will use clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive coding of patient care.

The role requires ICD-10 and CPT coding expertise, with 3–5 years’ hospital case management experience. Preferred qualification: Advanced coding certification; nursing degree is advantageous.

Qualifications

• Diploma/degree in Nursing is required.
• Advanced certification in Intermediate Coding is preferred.
• ICD-10/ CPT coding skills and understanding of diagnostic related groupers.

Responsibilities

• Plan, coordinate and execute Clinical coding in accordance with CHG standards.
• Ensure accurate, complete diagnostic and procedural coding of all patient records in hospital.
• Communicate with Funders (Medical Aids, COID, Government, RAF, DOL, etc.) regularly.
• Provide clinical information to Funders to update LOS, Level of Care, formulary use, devices and interventions as needed.
• Consult daily with health care providers regarding patient treatment.
• Maintain patient clinical status during hospitalization per funder requirements.
• Investigate funder, doctors, nurses and patient needs to deliver quality service.

Skills

Coding proficiency

Clinical knowledge

Funder coordination

Communication skills

Education

Diploma / Degree in Nursing

Advanced certification in Intermediate Coding

Degree in Nursing

Job description

JOB SUMMARY

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.

REQUIREMENTS

Minimum Requirements

• Diploma / Degree in Nursing.
• Preferred qualification: Advance certification in Intermediate Coding.
• ICD 10 Code and CPT coding ability and understanding of diagnostic related groupers.

Minimum Experience

• 3-5 years’ experience as a hospital Case Manager.

Added Advantage

• Degree in Nursing.

DELIVERABLES

• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols.
• Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital.
• 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 required change in the facility.
• Consult daily with all relevant health care providers with regards to patient treatment.
• Ensure the maintenance of patients’ clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalisation.
• Investigate and understand Funder, Doctors, Nurses and Patient needs to enable delivery of a quality service.