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.

Minimum Qualifications and Experience:

• Nursing Diploma
• Registered Nurse
• ICD Code & CPT Coding knowledge
• 3-5 years’ experience as a hospital case manager

Minimum Job Requirements:

• Liaise with Receptionist for authorizations.
• 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, DOL, etc.)
• Provide appropriate clinical information to Funders in order to update Length of Stay, Level of Care, formulary utilization, assistive devices / Prosthesis, diagnostic interventions, therapy intervention and procedural interventions and required change in the facility.
• Consult daily with all relevant health care providers with regards to patient treatment
• Ensure the maintenance of patients’ clinical status (subsequent interventions and treatments) in accordance to Funder requirements for the duration of hospitalization
• Ensure the correct categorization and management of different patient accounts to facilitate reimbursement by Funders.
• Ensure accurate and timeous finalization of cases to facilitate reimbursement by Funders.
• Minimize financial risk by the effective management of patient hospitalization.
• 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).