vacancy exists for a Case Administrator based at Life Anncron Hospital, reporting to Anita Pretorius, Patient Service Manager. The successful candidate will be responsible for case management administrative functions and to manage patient events not requiring updates (private, COID, day cases and predictables).

Critical Outputs
Ensure operational excellence -

Co-ordinate and distribute case management working reports to team.
Assist case managers to compile motivations where required and submit to the fund.
Assist case managers with in-patient going to theatre to get approval
Ensure effective management of real time and manual messaging, including requests, responses, rejections and submissions for cases assigned.
Ensure the accurate submission of accounts to funders.
Understand and ensure adherence to patient services policies and procedures.
Ensure compliance to service level agreements with internal and external stakeholders
Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.

Ensure effective management of revenue by -

Ensure accurate and complete coding of patient accounts.
Ensure the correct application and correct interpretation of funder RSRT contracts.
Ensure the correct application and correct interpretation of funder FFS claims.
Action and close off short payment queries associated with assigned responsibilities.
Report RSRT risks identified to manager.
Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.
Ensure effective management of quality outputs -

Adherence to ISO 9001 standards
Adherence to patient services escalation processes
Achieving Q-evaluator scores
Process alerts and incidents identified during the case management process
Investigate and comprehend published alerts / incidents and agree appropriate action with management.
Investigate and comprehend internal and external stakeholder complaints and agree appropriate action with management.
Drive adherence to customer service standards
Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.
Ensure effective management of relationships with internal/external stakeholders by

Foster and maintain healthy relationships with internal stakeholders. E.g. nursing, pharmacy and business hubs
Provide relevant feedback and information on concerns or issues raised by internal stakeholders
Provide and facilitate training regarding RSRT contracts to relevant internal stakeholders (e.g. pharmacy, pre-admission and nursing staff)
Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.
Provide relevant feedback and information on concerns or issues raised by external stakeholders
Provide feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process.
Escalate doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

Enrollled nurse or registered nurse, with at least 2 years healthcare experience
Current SANC registration
Knowledge of hospital patient services and case management processes
Knowledge and understanding of CPT & ICD coding
Knowledge of Funder contracts, scheme rules, exclusions and benefits
Understanding of private hospital industry and practices
Computer proficiency

Competencies

Attention to detail
Problem-solving, analysis and judgement
Resilience
Engaging diversity
Verbal & written communication skills
Professional and technical proficiency
Building relationships
Customer responsiveness
Organisational awareness
Influencing skills
Action orientation
Excellence orientation

Please send your resume/CV