Website Joint Medical Holdings
The Joint Medical Holdings Group was established almost 40 years ago in the 1980’s, by a group of doctors who wanted to provide accessible healthcare to disadvantaged communities during the apartheid years. By overcoming obstacles such as the Group Areas Act and with no defined roadmap to follow, … read morethe Group started its flagship facility, Isipingo Hospital, providing superior medical care to the local community. Today the Joint Medical Holdings Group includes a total of seven healthcare facilities operating across the KwaZulu – Natal province.
The Case Administrator is responsible for tracking of correspondences between Hospital and Medical Aid Schemes. Identify and monitor gaps, risk and assist with the implementation of correct actions agreed with management.
KEY PERFORMANCE AREAS
Track discharge files, review and ensure length of stay, level of care and coding approving
Review and ensure High-cost items are approved by the fund.
Call Medical Aids on the In patients to verify Codes submitted are covered by the fund
Check DSP listing/Procedure Co-payment listing, alert case manager of the amount member needs to pay
Assist with Forwarding ICD Coding /Theatre Time and Level of care to doctors’ rooms
Follow up on Outstanding DSM and Progress reports required by the Hospital Case Manager
Files that are closed by the Hospital Case Manager – Refers to Escalation Matrix, assist with sending to the relevant email addresses.
Assist with Auditing Bulletin and Provides a summary to Patient Services Manager on Outstanding updates.
COMPETENCIES (The following will be advantageous)
MINIMUM REQUIREMENTS
(Educational Qualifications & Experience)
Must have a Grade 12 qualification
Must be computer literate
Preferably have Delta 9 experience
ICD and CPT coding qualifications
Billing / Auditing experience will be advantageous.
Experience in a multidisciplinary hospital environment.
Must have experience in liaising with medical aids, doctors, and patients
Must have at Least 1 year customer services experience.
Must have least 1 year Hospital Admissions or Confirmations experience.
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