Case Administrator

Temporary

Position Summary

EE position: No

Introduction

A vacancy exists for a Case Administrator on a 6-month contract basis based at Life St Georges Hospital, reporting to Karen Gerber, Patient Services Manager. The successful candidate will be responsible for case management administrative functions and to manage patient events not requiring updates (private, COID, day cases and predictables).

Job description

 

Ensure operational excellence –
·        Co-ordinate and distribute case management working reports to team.
·        Assist case managers assigned to specialised wards to compile motivations where required and submit to the fund.
·        Ensure effective management of real time and manual messaging, including requests, responses, rejections and submissions for cases assigned.
·        Ensure the accurate submission of accounts to funders.
·        Understand and ensure adherence to patient services policies and procedures.
·        Ensure compliance to service level agreements with internal and external stakeholders
·        Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.
Ensure effective management of revenue by –
·        Ensure accurate and complete coding of patient accounts.
·        Ensure the correct application and correct interpretation of funder RSRT contracts.
·        Ensure the correct application and correct interpretation of funder FFS claims.
·        Action and close off short payment queries associated with assigned responsibilities.
·        Report RSRT risks identified to manager.
·        Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.
Ensure effective management of quality outputs –
·        Adherence to ISO 9001 standards
·        Adherence to patient services escalation processes
·        Achieving Q-evaluator scores
·        Process alerts and incidents identified during the case management process
·        Investigate and comprehend published alerts / incidents and agree appropriate action with management.
·        Investigate and comprehend internal and external stakeholder complaints and agree appropriate action with management.
·        Drive adherence to customer service standards
·        Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.
Ensure effective management of relationships with internal/external stakeholders by
·        Foster and maintain healthy relationships with internal stakeholders. E.g. nursing, pharmacy and business hubs
·        Provide relevant feedback and information on concerns or issues raised by internal stakeholders
·        Provide and facilitate training regarding RSRT contracts to relevant internal stakeholders (e.g. pharmacy, pre-admission and nursing staff)
·        Identify and monitor gaps and risks and assist with the implementation of corrective actions agreed with management.
·        Provide relevant feedback and information on concerns or issues raised by external stakeholders
·        Provide feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process.
·        Escalate doctor non-compliance in terms of RSRT framework to RSRT meetings

 

Minimum requirements

 

·        Enrollled nurse, with at least 2 years healthcare experience
·        Current SANC registration
·        Knowledge of hospital patient services and case management processes
·        Knowledge and understanding of CPT & ICD coding
·        Knowledge of Funder contracts, scheme rules, exclusions and benefits
·        Understanding of private hospital industry and practices
·        Computer proficiency
Competencies:
·        Attention to detail
·        Problem-solving, analysis and judgement
·        Resilience
·        Engaging diversity
·        Verbal & written communication skills
·        Professional and technical proficiency
·        Building relationships
·        Customer responsiveness
·        Organisational awareness
·        Influencing skills
·        Action orientation
·        Excellence orientation
·        Ethical behaviour