Senior Credit Portfolio & Risk Assurance Manager

Posted: 02-10, Closing: 02-24

Location: Gauteng, Roodepoort

Description:

A vacancy exists for a Clinical Case Manager, reporting to the COO. The position's primary responsibilities include group oversight ensuring efficient patient case management and the delivery of an efficient and professional service to internal and external customers.

Critical Outputs:

1. Carry out clinical coding in accordance with CPT and ICD requirements.
2. Ensure that pre-admission and pre-authorisation information is accurate and in accordance with hospital and funder procedures.
3. Maintain patients' clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients informed and managing the entire hospital stays' financial risk.
4. Provide complete and accurate updates and discharge information of all accounts.
5. Maintain accurate accounts of all admissions.
6. Conduct Case Management training for the Group.
7. Handle patient files in accordance with hospital procedures.
8. Timeous electronic submission of accounts and follow up on short payments arising from case management related issues.
9. Ensure the adherence of hospital staff to funder rules and coding procedures.
10. Keep well informed on legislation pertaining to funders and related Health Care matters.

Requirements:

1. SANC registration as a Registered Nurse.
2. High school matric certificate.
3. 3 – 5 years' experience in basic finance and Medical Aid administration procedures will be an advantage.
4. Knowledge of hospital billing and tariffs would be an advantage.
5. Willingness to travel.
6. Sound computer literacy skills and working knowledge of MS Office, Word, and Excel.
7. Excellent communication skills and the ability to form and build strong partnerships.
8. Excellent negotiation skills & the ability to interact with tact and diplomacy.

Departments: Nursing

Africa Health Care Head Office is an equal opportunity employer; external candidates will also be considered.

Only shortlisted candidates will be contacted.

Should you not receive any communication after 2 weeks of the closing date, kindly consider your application as unsuccessful.