Clinical Case Manager – Africa Health Care Head Office Job at Africa Health Care

Critical Outputs

• Review clinical coding in accordance with CPT and ICD requirements at group level
• Ensure that pre-admission and pre-authorisation processes are maintained
• Maintain patients’ clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients administration teams informed and managing the entire hospital stays’ financial risk in support of the Group Patient Administration and Billings Manager
• Ensure Group Clinical updates are submitted timeously as per group tracker
• Provide Training on ICD/CPD Coding
• Ensure group LOC/LOS parameters are maintained
• DRG Tracking implementation
• Ensure the adherence of hospital staff to funder rules and coding procedures
• Keep well informed on legislation pertaining to funders and related Health Care matters

Requirements

• Candidates who are registered with SANC as a Registered Nurse or Enrolled Nurse, registered with SAPC as a Pharmacist, registered with the HPCSA as an ALS or ACLS.
• High school matric certificate
• 5+ years’ experience of basic finance and Medical Aid administration procedures
• Knowledge of hospital billing and tariffs
• Have sound computer literacy skills and working knowledge of MS office, word and excel.
• Excellent communication skills and the ability to form and build strong partnerships
• Excellent negotiation skills & the ability to interact with tact and diplomacy

Competencies

• Collaboration/ Relationship Building
• Problem-solving, analysis and judgement
• Resilience
• Engaging diversity
• Verbal & written communication and presentation skills
• Influencing
• Customer responsiveness
• Organisational awareness
• Excellence and quality orientation
• Ethical behaviour
• Departments
• Admin
• Nursing