Job Description
- Responsible for the case management process within the hospital.
- Conduct ward rounds and ensure the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians.
- Update accurate clinical information to justify, length of stay (LOS) and level of care (LOC) to medical funds the assigned managed care organization.
- Update and provide the necessary information to funders regarding HV (high value) items, limited benefits and protocols as defined by managed care organizations.
- Communicate funder requirements / responses to attending clinicians and patients where necessary, and ensure compliance with industry standards.
- Ensure effective management of real time and manual messaging, including request, responses, rejections and submissions.
- Ensure the accurate submission of accounts to funders.
- Understand and ensure adherence to patient’s services policies and procedures.
- Ensure accurate and complete coding of patient accounts.
- Ensure the correct application and correct interpretation of funder contracts.
- Ensure the correct application and correct interpretation of funder FFS claims.
- Action and close off short payment queries associated with assigned responsibilities.
- Interacts with medical schemes to ensure that authorisations are provided timeously.
- Ensures accurate application and interpretation of specialised wards criteria.
- Provides support for the management of alternative fee structures.
- Maintains client service principles to ensure client expectations are met.
Company Profile:
Salary: Not disclosed
Industry: Medical / Healthcare / Hospital
Functional Area:
Role Category: Others
Employment Type: Full time
Keyskills
