A vacancy exists for a Case Administrator based at Life Vincent Pallotti, reporting to Ester VD Walt, Manager’s job title. The successful candidate will be responsible for case management administrative functions and to manage patient events not requiring updates (Oncology related).

 

Critical Outputs

Ensure operational excellence -

 

Ensure effective management of real time and manual messaging, including requests, responses, rejections and submissions for cases assigned.

Ensure the accurate submission of accounts to funders.

Understand and ensure adherence to patient services policies and procedures.

Ensure compliance to service level agreements with internal and external stakeholders

Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.

Ensure effective management of revenue by -

 

Ensure accurate and complete coding of patient accounts.

Ensure the correct application and correct interpretation of funder RSRT contracts.

Ensure the correct application and correct interpretation of funder FFS claims.

Action and close off short payment queries associated with assigned responsibilities.

Report RSRT risks identified to manager.

Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.

Ensure effective management of quality outputs -

 

Adherence to ISO 9001 standards

Adherence to patient services escalation processes

Achieving Q-evaluator scores

Process alerts and incidents identified during the case management process

Investigate and comprehend published alerts / incidents and agree appropriate action with management.

Investigate and comprehend internal and external stakeholder complaints and agree appropriate action with management.

Drive adherence to customer service standards

Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.

Ensure effective management of relationships with internal/external stakeholders by

 

Foster and maintain healthy relationships with internal stakeholders. E.g. nursing, pharmacy and business hubs

Provide relevant feedback and information on concerns or issues raised by internal stakeholders

Provide and facilitate training regarding RSRT contracts to relevant internal stakeholders (e.g. pharmacy, pre-admission and nursing staff)

Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.

Provide relevant feedback and information on concerns or issues raised by external stakeholders

Provide feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process.

Escalate doctor non-compliance in terms of RSRT framework to RSRT meetings

 

Requirements

 

Enrollled nurse, with at least 2 years healthcare experience

Current SANC registration

Knowledge of hospital patient services and case management processes

Knowledge and understanding of CPT & ICD coding

Knowledge of Funder contracts, scheme rules, exclusions and benefits

Understanding of private hospital industry and practices

Computer proficiency

 

Competencies

 

Attention to detail

Problem-solving, analysis and judgement

Resilience

Engaging diversity

Verbal & written communication skills

Professional and technical proficiency

Building relationships

Customer responsiveness

Organisational awareness

Influencing skills

Action orientation

Excellence orientation

Ethical behaviour

 

Interested candidates can send their CVs