Job Description

Manage the Admin Department and processes with regards to non-releases



Manage the Credit Control queries



Manage Case Manager updates and escalations for Medical Aids



Ensure accurate ICD 10 and CPT Coding



Analysis of Billing errors



Managing Fixed Fee Contracts with Medical Aids



Management of staff



Daily and Monthly reporting to Hospital Manager and Head Office regarding Admin stats



Month end finalisation of files



Private patients' quotations, Financial Risk Management and daily banking



Auditing of Hospital folder greater than 10K



Auditing coding on claims and checking if co-morbidities have been captured



Auditing of clinical data submitted to the Medical funder / aid / institute



Ensuring that the high cost medication process has been followed



Responsible for the security and accuracy of the patient records



Liaise with the relevant stakeholders regarding claims, billings etc. and ensure that all claims / queries have been actioned by the relevant staff members within the Department



Oversee and streamline the billing processes



Plan and implement quality assurance for all billing and case management processes



Conduct routine staff meetings regarding billing planning and implementations



Assist in standardising the methods in which work will be accomplished



Ensure that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol and follow company healthcare regulations, guidelines and requirements, review departmental procedures and evaluate the effectiveness of personnel



Understand and remain updated with current coding and billing regulations, compliance requirements and scheme rules changes / requirements



Provide, oversee, and/or coordinate the provision of training for new and existing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques



Checking of daily reports



Ward report - ensure all patients are allocated to a Case Manager and updated accordingly



Non-Release - ensure all discharge folders are received



Medikredit Control Panel - ensure all claims are accurate and submitted accordingly



Checking daily Theatre slates



Follow up on daily, weekly and monthly queries



Assist staff members with escalation of claims, queries, billings and LOM requests



Grade 12



An applicable tertiary qualification will be an advantage



A minimum 3 - 5 years Management or Supervisory experience



Knowledge of ICD 10 and CPT Coding



Knowledge of Medical Aid Rules and Fixed Fee Contracts with Funders



In depth knowledge and understanding of Private Hospital Billings guidelines



General accounting knowledge and financial skills



Ability to work well under pressure and function independently



Excellent computer skills



Between 3 - 5 Years