Company description: The Clinix Health Group help communities to live longer healthier lives through the provision of quality and affordable healthcare. The group provide integrated world-class healthcare systems both internally and externally to the broader ecosystem in order to become a trusted local citizen.   

 Job Title                               :Case Manager

Location                                :Clinix Health Group – Hospital/s       

Reports to                             :Patient Services Manager

JOB SUMMARY
To plan, coordinate and execute case management work at hospital level. The incumbent utilises clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care.

REQUIREMENTS

Minimum Qualifications:

• Diploma/Degree in Nursing,
• Registered nurse , currently registered with SANC
• Certificate in Basic / Intermediate Clinical Coding

Minimum Experience:

• Must have 3 to 5 years’ experience in a private hospital or medical scheme environment in a Case management capacity

Key Competencies:

• Hospital Operations
• Coding standards and protocols
• Working knowledge of core specialties in facility
• Knowledge of private health care operations
• Working knowledge of ICD-10 and CPT coding
• Computer proficiency – SAP System or similar
• Conflict management
  

    DELIVERABLES

• Ensure authorizations on admissions (daily) is accurate as per SAP system.
• Ensure compliance to case management procedures, standards and protocols
• Plan, coordinate and execute Clinical coding in accordance with relevant CHG standards and protocols
• Ensure accurate, appropriate and complete diagnostic and procedural coding of all patient records in the hospital
• Timeously and consistently communicate and follow up with Funders (Medical Aids, COID, Government, RAF, etc.)
• Ensure the maintenance of patients’ clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalization
• Ensure the correct categorisation and management of different patient accounts to facilitate reimbursement by Funders
• Minimise financial risk by the effective management of patient hospitalisation
• Follow the established and approved escalation processes in the event of a decline of payment by Funders
• Ensure to remain in the group and facility targets of 3 days for WIP (work in progress) and DNYB (discharged not yet billed)
• Ensure timeous resolution of stakeholder queries and complaints and take ownership of case management and reimbursement related issues
• Ensure financial and case management documentation is maintained to support accurate record keeping and future requirements as per legislation and CHG standards
• Adhere to statutory standards, policies and procedures within the business unit to ensure compliance at all times and take remedial action where necessary.