Assess patient conditions and needs to develop appropriate care plans
Interact with patients and medical aid schemes
Resolve patient and medical aid scheme queries
Update all information timeously and accurately
CPT and ICD coding
Obtain doctors letters, motivations, and justifications in all appropriate cases under managed care of where medical aids request them from their hospitals as part of their assessing process
Monitor patient admissions and identify those who have limitations, restrictions, place by their managed care/ medical aid structures e.g. length of stay, cost restrictions, fixed fees, per diem and other limiting fees or drugs and/ or formularies
Maintain a control system that ensures the systematic monitoring of managed care patients
Handling patient queries
Update hospital information
Requirements
Qualified Registered Nurse
A qualified EN with relevant experience would be considered
Both need to registered with SANC and proof of indemnity cover
Minimum 3 years nursing experience in a multidisciplinary hospital.
Experience and exposure in Theatre and/or ICU would be advantageous
Hospital or Medical Aid scheme case management would be an advantage.
Experience in ICD 10 and CPT coding is essential
Knowledge of Prescribed Minimum Benefits (PMB) Scheme rules and policies
Excellent communication skills (written and spoken)
Excellent analytical and problem-solving skills
Excellent MS Office computer skills, i.e. Outlook, Word, Excel, Kronos, Clinic Manager, etc.
