A vacancy exists for a Case Manager General Ward based at Life Bay View Private Hospital, reporting to Susan Visser, Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient in a general ward by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalization to achieve strategic objectives.

Critical Outputs
Ensuring the maximization of revenue by

Ensuring accuracy of coding
Ensuring the correct application and interpretation of RSRT’s
Participating in meetings and reporting losses to RSRT team and recommend corrective actions
Monitoring insurance verification and workflow processes
Ensuring effective management of quality outputs by

Performing quality walkabouts and implement corrective measures
Implementing and monitoring quality improvement programmes
Adhering to patient services escalation processes to achieve QMS targets
Monitoring Q-evaluator scores and implementing corrective measures
Investigating internal and external stakeholder complaints
Ensuring the adherence to customer service standards
Ensuring operational excellence by

Monitoring submission of accurate accounts to funders
Updating length of stay and level of care to funders of general ward cases and where operationally required specialised unit cases.
Releasing care risk targets and submission within two days of discharge
Ensuring the compliance to LHC policies and managing authorisations and claim submissions, rejections and delays
Ensuring governance and risk management by monitoring and adhering to patient services policies and procedures
Ensuring compliance to service level agreements with internal and external stakeholders
Ensuring all billing checks are closed by the relevant function areas
When operationally required, relieve as either-or specialised case manager, bill auditor or preadmission clinical assessor.
Ensuring effective management of relationships with internal/external stakeholders by

Building and maintaining relationships with internal stakeholders
Providing feedback and information on concerns or issues raised by internal stakeholders
Providing and facilitating training regarding RSRT contracts to the relevant internal stakeholders
Ensuring effective communication with external stakeholders
Managing escalated concerns from Case Managers with external stakeholders
Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

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.
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 behavior

Please send your resume/CV