Job Description

• Provide effective leadership by offering guidance, support, and direction to the Case Management and Billings team members, ensuring the department operates efficiently.
• Provide training and development opportunities for Case management and Billings team members on relevant operating policies, protocols, systems, procedures, standards, and techniques.
• Ensure the recruitment of experienced & suitably qualified team members to fill approved vacancies in alignment with HR recruitment processes.
• Ensure effective onboarding and integration of new staff members into the team.
• Facilitate regular team meetings to review progress, address concerns, share updates, and discuss billing planning and implementation.
• Provide feedback to team members regarding their performance and implement corrective actions as necessary.
• Ensure team alignment with corporate values and culture.
• Manage the financial risk and working capital of the hospital by ensuring accurate and timely case management updates and billing of patient records.
• Ensure that Case management and Billing operations are conducted in accordance with departmental protocols and comply with healthcare
• Implement strategic goals and objectives to enhance operational efficiency and ensure the achievement of key targets.
• Analyse case management/ billing errors and develop quality improvement plans.
• Monitor and manage the in-patients report for long-stay, private, and insured patients, identifying any associated risks and ensuring that all tariff charges are accurate and up to date.
• Ensure that the Case Managers adhere to their agreed TAT by updating in-patient admissions and attending to high-value in-patient cases daily.
• Audit coding on claims and verify that co-morbidities have been captured.
• Audit clinical data submitted to the medical funder/aid/institute to ensure accuracy and compliance.
• Ensure adherence to the high-cost medication processes.
• Monitor and report on variances in Fixed Fees and Managed Health Care.
• Manage cancelled / requests for reversals of claims for changes to LOC, LOS, CPT or ICD codes effectively.
• Assist staff members with the escalation of claims, queries, billing, LOM requests, and to resolve complex issues.
• Understand and remain updated with current coding and billing regulations, compliance requirements, and scheme rules changes.
• Ensure the timely submission of all reports to the relevant stakeholders.
• Monitor and review the following reports daily to ensure accuracy and completeness:

Ward Report - Ensure all patients are allocated to a Case Manager and that their information is updated accordingly.
Non-Release Report - Ensure all discharge folders are received.
Medikredit Control Panel Report - Ensure all claims are accurate and submitted accordingly.
Theatre Slate Report - Monitor and ensure timeous updates and identify risks.

• Liaise with the Credit Control Department regarding claims, billing, and related matters, ensuring that all queries are addressed and actioned by the relevant staff members.
• Ensure POPI compliance and accurate record keeping of patient records
• Consult with HODs, Hospital Management, Head Office Management, and Specialists to review departmental procedures and operational effectiveness.

• Minimum of 5 years' experience in hospital administration
• Knowledge of ICD 10 and CPT Coding
• In-depth knowledge and understanding of Private Hospital Billings guidelines
• Knowledge of Medical Aid Rules and Fixed Fee Contracts with Funders
• Excellent Computer skills
• Excellent administration and organization skills
• Strong leadership and management abilities
• Strong interpersonal and communication skills
• The ability to work well under pressure
• Excellent attention to detail
• The ability to function independently
• Excellent time management skills

Skills Required