Case Administrator - Isipingo

DIVISION:ISIPINGO HOSPITAL                                                                     JOB TITLE:CASE ADMINISTRATOR PURPOSE OF POSITION

The Case Administrator is responsible for tracking of correspondences between Hospital and Medical Aid Schemes. Identify and monitor gaps, risk and assist with the implementation of correct actions agreed with management.

KEY PERFORMANCE AREAS

Track discharge files, review and ensure length of stay, level of care and coding approving

Review and ensure High-cost items are approved by the fund.

Call Medical Aids on the In patients to verify Codes submitted are covered by the fund

Check DSP listing/Procedure Co-payment listing, alert case manager of the amount member needs to pay

Assist with Forwarding ICD Coding /Theatre Time and Level of care to doctors' rooms

Follow up on Outstanding DSM and Progress reports required by the Hospital Case Manager

Files that are closed by the Hospital Case Manager – Refers to Escalation Matrix, assist with sending to the relevant email addresses.

Assist with Auditing Bulletin and Provides a summary to Patient Services Manager on Outstanding updates.

COMPETENCIES (The following will be advantageous)

MINIMUM REQUIREMENTS

(Educational Qualifications & Experience)

Must have a Grade 12 qualification

Must be computer literate

Preferably have Delta 9 experience

ICD and CPT coding qualifications

Billing / Auditing experience will be advantageous.

Experience in a multidisciplinary hospital environment.

Must have experience in liaising with medical aids, doctors, and patients

Must have at Least 1 year customer services experience.

Must have least 1 year Hospital Admissions or Confirmations experience.