Case Manager 2 Posts

PROVINCIAL ADMINISTRATION: WESTERN CAPE DEPARTMENT
DEPARTMENT OF AGRICULTURE
Directorate: Management Accounting
SALARY : R281 418 per annum
CENTRE : (Head Office, Cape Town)
CLOSING DATE : 01 September 2017

REQUIREMENTS :
Minimum educational qualification: A health related qualification registrable with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANC).
Experience: Appropriate experience in Case Management/Medical Aid Environment and Revenue Generation.
Inherent requirements of the job: Willingness to travel and spend long periods away from the office.
Valid (Code B/EB) drivers licence.
Competencies (knowledge/skills): Good knowledge of the Uniform Patient Fees Schedule (UPFS), Managed Health 63 Care or Hospital Information Systems and EDI (Electronic Data Interchange).
Knowledge of the Medical Schemes Act 131 of 1998 and the application of Prescribed Minimum Benefit (PMB) legislation i.
e.
the Chronic Disease List (CDL) and Diagnostic Treatment Pairs (DTP).
Experience in ICD-10 Code assignment and the ability to link patient diagnosis with procedural codes.
Ability to work with Excel spread sheets, Microsoft Word and web based programs (medical aids).
Note: No payment of any kind will be required when applying for this post.
This post will not be linked to any of the Occupational Specific Dispensations.
Candidates who applied previously need not to apply again.

DUTIES :
(key result areas/outputs): Assist various institutions with clearing of externally funded revenue back logs related to ICD-10 code assignment, UPFS assignment and the management of PMB conditions.
Assist various Hospital Fees Departments with follow-up of outstanding medical scheme and state department balances and account queries.
Conduct clinical audits of patient accounts to ensure accuracy of invoices for submission to medical aids and state departments.
Perform operational Case Management functions at various institutions inclusive of pre-authorisation and clinical review to ensure compliance with Case Management policies and procedures.
Assist with EDI rejections to ensure timeous submission of medical scheme invoices.
Provide quotations to H2, H3 and Foreign patients.
Assist with the implementation of departmental case management policies and procedures by providing onsite skills development and training of relevant role players in matters relating to Case management.

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