Clinical Case Manager: Patient Billing & Care Coordination

Business Unit: Royal Buffalo Specialist Hospital

Location: Eastern Cape, East London

A vacancy exists for a Case Manager, reporting to the Patient Administration Manager. The position's primary responsibilities include efficient patient case management and the delivery of an efficient and professional service to the internal and external customers. The successful candidate will be goal oriented with strong customer, quality, and performance focus.

• Carry out clinical coding in accordance with CPT and ICD requirements
• Ensure that pre-admission and pre-authorisation information is accurate and in accordance with hospital and funder procedures.
• Maintain patients' clinical status in accordance with funder approval requirements for the duration of hospitalization; keeping patients informed and managing the entire hospital stays' financial risk
• Provide complete and accurate updates and discharge information of all accounts
• Maintaining accurate accounts of all admissions
• Handle patient files in accordance with hospital procedures
• Timeous electronic submission of accounts and follow up on short payments arising from case management related issues.
• Ensure the adherence of hospital staff to funder rules and coding procedures
• Keep well informed on legislation pertaining to funders and related Health Care matters

• SANC registration as an RN
• High school matric certificate
• 3 - 5 years' experience of basic finance and Medical Aid administration procedures will be an advantage
• Knowledge of hospital billing and tariffs would be an advantage.
• Have sound computer literacy skills and working knowledge of MS office, word and excel.
• Excellent communication skills and the ability to form and build strong partnerships
• Excellent negotiation skills & the ability to interact with tact and diplomacy

• Collaboration/ Relationship Building
• Problem-solving, analysis and judgement
• Resilience
• Verbal & written communication and presentation skills
• Organisational awareness
• Excellence and quality orientation
• Ethical behaviour
• Decision making

Departments: Admin, Finance

Royal Buffalo Specialist Hospital is an equal opportunity employer, external candidates will also be considered. Only shortlisted candidates will be contacted, should you not receive any communication after 2 weeks of closing date kindly consider your application as unsuccessful.