Case Manager
Clinix Health Group (Pty) Ltd Soweto, Gauteng
Job Description
- 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).
Requirements
- Nursing Diploma
- Registered Nurse
- ICD Code & CPT Coding knowledge
- 3-5 years’ experience as a hospital case manager