Hospital Case Manager: Billing and Care Coordination

Africa Health Care; Mthatha; On-site; ZAR 350,000 - 450,000; Full time

Job summary

Herolim Private Hospital in the Eastern Cape seeks a Case Manager to oversee patient case management and ensure efficient service delivery to clients and funders. You will work under the Patient Administration Manager and focus on quality, accuracy, and timely financial interactions.

The ideal candidate has SANC RN registration, Matric, and 3–5 years’ experience in finance and Medical Aid administration, with strong communication and negotiation skills. Proficiency in MS Office is essential.

Qualifications

• SANC registration as an RN.
• High school matric certificate.
• 3–5 years’ experience of basic finance and Medical Aid administration procedures will be an advantage.
• Knowledge of hospital billing and tariffs would be an advantage.
• Sound computer literacy skills and working knowledge of MS Office, Word and Excel.
• Excellent communication skills and the ability to form and build strong partnerships.
• Excellent negotiation skills & the ability to interact with tact and diplomacy.
• Collaboration/ Relationship Building
• Problem-solving, analysis and judgement
• Resilience
• Verbal & written communication and presentation skills
• Excellence and quality orientation
• Ethical behaviour

Responsibilities

• Carry out clinical coding in accordance with CPT and ICD requirements.
• Ensure that pre-admission and pre-authorisation information is accurate and in accordance with hospital and funder procedures.
• Maintain patients’ clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients informed and managing the entire hospital stays’ financial risk.
• Provide complete and accurate updates and discharge information of all accounts.
• Maintaining accurate accounts of all admissions.
• Handle patient files in accordance with hospital procedures.
• Timeous electronic submission of accounts and follow up on short payments arising from case management related issues.
• Ensure the adherence of hospital staff to funder rules and coding procedures.
• Keep well informed on legislation pertaining to funders and related Health Care matters.

Skills

Communication

Negotiation

Relationship building

Problem solving

Resilience

Verbal & written comms

Education

RN registration (SANC)

Matric certificate

Job description

Herolim Private Hospital in the Eastern Cape seeks a Case Manager to oversee patient case management and ensure efficient service delivery to clients and funders. You will work under the Patient Administration Manager and focus on quality, accuracy, and timely financial interactions.

The ideal candidate has SANC RN registration, Matric, and 3–5 years’ experience in finance and Medical Aid administration, with strong communication and negotiation skills. Proficiency in MS Office is essential.