Billing Operations Cluster Non-Clinical Case Manager

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ROLE SUMMARY

The Non-Clinical Case Manager mitigates financial risk by providing justification of the hospitalisation, encompassing level of care and length of stay to fund administrators. Non-Clinical Case Managers work collaboratively with clinical coders to provide complete clinical coding of the hospital event. The incumbent will be responsible for liaising between the patients, treating clinicians and managed care organisations to provide an accurate clinical motivation/indication of the patient’s stay in hospital. The Non-Clinical Case Manager is an integral part of a team, alleviating the administrative burden of the Case Manager which have a similar, but clinical focus. The Non-Clinical Case Manager works with the billings manager to achieve the billing cluster KPIs.

KEY WORK OUTPUT AND ACCOUNTABILITIES

DISRUPTIVE INNOVATION

Case Management

• Systematic application of knowledge to ensure complete case management of a patient’s event in terms of LOS, LOC and medical aid benefits.
• Provide electronic data to substantiate length of stay and level of care for patient’s stay in hospital.
• Ensure correct clinical coding for all patients as per clinical coding SOP.
• Apply knowledge to ensuring that materials and services are correctly classified on the system.
• Escalation of case management trends to the BOC Billings Manager for discussion in funder operational meetings.
• Monitoring the patients in progress report and ensuring that patients ward movements, bed status and level of care on the system is accurate.
• Facilitate discharge planning and movement of patients to step-down or rehab facilities.
• Efficient management of e-queries as allocated on Debtpack.
• Assist with any other duties assigned by the BOC and Billings Manager from time to time.
• Apply acquired case manager knowledge for the resolution of rejections of patient accounts in terms of LOS and LOC.

Diagnostic and procedural coding

• Ensure appropriate, complete, and relevant diagnostic and procedural coding of all patient records within the cluster while the patient is in progress.
• Make use of Health Code Index.

Build and maintain stakeholder relationships

• Liaise with a network of internal and external stakeholders to ensure final billing.
• Develop collaborative relationships to help accomplish work goals.

Effective communication

• Effective communication to medical schemes by utilising the rules of engagement published in the Netcare Tariff and Billing Guidelines.
• Effective communication, collaboration and consultation with other role players in the healthcare team.

Legal compliance

• Compliance with all industry relevant legislative acts, regulations and circulars.
• Compliance with Group Policies, Procedures and Processes.

TRANSFORMATION OF OUR SOCIET

Training and development

• Identify own training needs and communicate with line manager.
• Formal coding training via Insight platform is compulsory.
• Onboarding Non-Clinical Case Manager Insight training is compulsory.

Teamwork

• Actively participate as a member of a team to achieve daily goals, so that work allocation is not carried over to the next day.

Personal and professional development

• Active involvement in own professional development to maintain a satisfactory level of skill and knowledge.
• Keep up to date with Netcare’s evolving policies and procedures.

SKILLS PROFILE

EDUCATION

Required

• DUXAH Non-clinical Case Manager qualification or equivalent.

WORK EXPERIENCE

Required

• 1 year hospital internship either before or after successful completion of Non-clinical Case Manager qualification.
• General administrative skills.
• Computer literate.

KNOWLEDGE

Required

• Understanding of a patients journey in the private healthcare environment from patient admission to final billing.

PHYSICAL REQUIREMENTS

In the event of any physical or psychological limitation that may impair the employee’s ability to perform the required job function, the employee must consult the employer for reasonable accommodation.

WORKING CONDITIONS

• Professional flexibility in working hours while supporting daily business operations which may include weekends and night shifts where applicable.
• Will interact with internal and external customers through several different means.

Join the team committed to providing the best and safest health and care.