Senior Case Manager (Clinical & Financial) - Roodepoort

Senior Case Manager (Clinical & Financial) - Roodepoort

Our client, a private hospital based in Roodepoort, is seeking to recruit a Senior Case Manager.

Duties & Responsibilities:

1. Ensuring the maximisation of revenue by:
   1. Ensuring accuracy of coding
   2. Ensuring the correct application and interpretation of RSRTs
   3. Participating in meetings and reporting losses to RSRT team and recommending corrective actions
   4. Monitoring insurance verification and workflow processes
2. Ensuring effective management of quality outputs by:
   1. Performing quality walkabouts and implementing corrective measures
   2. Implementing and monitoring quality improvement programmes
   3. Adhering to patient services escalation processes in order to achieve QMS targets
   4. Monitoring Q-evaluator scores and implementing corrective measures
   5. Investigating internal and external stakeholder complaints
   6. Ensuring adherence to customer service standards
3. Ensuring operational excellence by:
   1. Monitoring submission of accurate accounts to funders
   2. Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases
   3. Releasing care risk targets and submission within two days of discharge
   4. Ensuring compliance to LHC policies and managing authorisations and claim submissions, rejections and delays
4. Ensuring governance and risk management by:
   1. Monitoring and adhering to patient services policies and procedures
   2. Ensuring compliance to service level agreements with internal and external stakeholders
   3. Ensuring all billing checks are closed by the relevant function areas
5. Ensuring effective management of relationships with internal / external stakeholders by:
   1. Building and maintaining relationships with internal stakeholders
   2. Providing feedback and information on concerns or issues raised by internal stakeholders
   3. Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders
   4. Ensuring effective communication with external stakeholders
   5. Managing escalated concerns from Case Managers with external stakeholders
   6. Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Qualifications & Requirements:

1. Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants, or Emergency Care Practitioners, or any other qualification that covers Anatomy, Physiology, Pathophysiology, and Microbiology as foundational courses.
2. Current SANC / HPCSA registration
3. Knowledge of hospital patient services and case management processes
4. Knowledge and understanding of CPT & ICD coding
5. Knowledge of Funder contracts, scheme rules, exclusions, and benefits
6. Understanding of private hospital industry and practices
7. Computer proficiency

Start Date: ASAP

Only candidates who meet all the minimum requirements stipulated in the advert will be considered.

If you do not hear from us within two weeks of your application, please consider your application as unsuccessful.