About this role
We provide meaningful careers that connect people with purpose.
We are united by a common purpose of providing the best and safest care; and by our shared values of Care, Truth, Participation, Compassion and Dignity.
Netcare invites you to be part of our journey.
• Apply clinical knowledge with regards to risk management of patient’s event in terms of LOS, LOC and medical aid benefits.
• Apply clinical knowledge with regards to rejection management (financial and clinical) of patients in terms of LOS, LOC and coding.
• Provide electronic clinical 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 clinical 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.
• 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.
• Liaise with a network of internal and external stakeholders to ensure final billing.
• Develop collaborative relationships to help accomplish work goals.
• 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.
• Compliance with all industry relevant legislative acts, regulations and circulars.
• Compliance with Group Policies, Procedures and Processes.
• Identify own training needs and communicate with line manager.
• Identify and ensure informal training for all relevant staff related to managed healthcare subject matter.
• Formal coding training via Insight platform is compulsory.
• Onboarding case manager Insight training to be completed.
• Actively participate as a member of a team to achieve goals.
• 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.
Join the team that providing the best and safest
care.
Other facts
About Netcare
The Netcare Group (JSE: NTC) offers a unique, comprehensive range of medical services across the healthcare spectrum, enabling us to serve the health and care needs of each individual who entrust their care to us. Our focus on implementing sophisticated digital systems will enable us to provide care that is fully integrated and an enhanced experience across our Group's operations. At Netcare, we are striving to change healthcare for the better. In addition to its world-class acute private hospital services, Netcare provides:
o radiosurgery, radiotherapy, chemotherapy, bone marrow transplant and robotic-assisted surgery through Netcare Cancer Care;
o primary healthcare services through Medicross;
o emergency medical services through Netcare 911;
o occupational health and employee wellness services through Netcare Occupational Health;
o mental health and psychiatric services through Akeso;
o innovative solutions to increase access to quality and affordable private healthcare through NetcarePlus;
and o renal dialysis services through National Renal Care (NRC).
Netcare is also a leading private trainer of emergency medical and nursing personnel in the country.
For more information visit www.netcare.co.za.
What you'll do
- The BOC Case Manager is responsible for applying clinical knowledge to manage patient care, including risk management, coding, and discharge planning. They will also ensure accurate clinical data and coding, facilitate patient movements, and communicate effectively with stakeholders.
Ready to join Netcare?
Take the next step in your career journey