Case Manager Specialist

at Life Wilgers Hospital
Location Pretoria, South Africa
Date Posted May 13, 2022
Category Management
Job Type Full-Time

Description

 

A vacancy exists for a Case Manager Specialist, based at Life Wilgers Hospital, reporting to the Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks of the patient event by ensuring accurate coding, clinical updates and accounts submissions of patient hospitalisation to achieve key strategic objectives.

 

Critical Outputs

Maximisation of correct revenue

Drive and ensure correct application and correct interpretation of RSRT's, accuracy of coding and compliance to Company policies regarding authorisations.

Manage and monitor input on Impilo, manage re authorisations, rejections and delays, monitor insurance verification, submission of accurate accounts to Funders and adhoc reports.

Ensure timeous update of patient events as per Life Healthcare policies and protocols.

Adhere to ISO 9001 standards and patient escalation processes.

Ensure compliance of SLA’s with internal stakeholders, foster positive professional relationships.

Ensure compliance in terms of the RSRT framework.

Effective communication pertaining to patient queries, submission of motivation letters required and short payments.

 

Requirements

 

A registered nurse with a qualification or experience in Intensive Nursing Science

Clinical Coding experience of at least one year and / qualification in clinical coding (ICD 10 and CPT coding).

Case management experience.

Knowledge of Impilo and or IMEDS would be advantageous.

Knowledge of funder contracts, rules, copayments and exclusions would be advantageous.

Computer proficiency in MS Office.

 

Competencies

 

Problem-solving, analysis and judgement

Resilience

Engaging diversity

Influencing

Drive & energy

Excellence orientation

Ethical behaviour

Building relationships

Customer responsiveness

Organisational awareness

 

Interested candidates can send their CV

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