Reference Number: Argus/Burger 5/12/2015, Southern Mail 9/12/2015
Component: Department of Health
Institution: Victoria Hospital
Minimum educational qualification:
- A health related qualification registrable with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANC).
- Appropriate experience in Case Management/Medical Aid environment and Managed Health Care policies and protocols, optimal fund utilisation and updating clinical information.
- Experience in ICD-10 diagnostic and procedural code assignment.
- Good knowledge of Uniform Patient Fee Schedule, ICD-10 diagnostic codes and the Medical Schemes Act 131 of 1998 and Regulations, i.e. PMB legislation.
- Knowledge of EDI (Electronic Data Interchange), Managed Health Care standards and patient billing.
- Ability to link patient diagnoses with procedure codes.
- Good verbal and written communication skills in at least two of the three official languages of the Western Cape.
Duties (key result areas/outputs):
- Perform hospital Case Management functions with regards to authorisation, benefit management and the communication of clinical information for externally funded clients.
- Co-ordinate the workflow processes between clinical and admin personnel by liaising, guiding and supporting various role players within the hospital with the identification of ICD-10 codes, prescribed minimum benefits and account queries.
- Conduct clinical audits of Medical Aids and State Departments, e.g. RAF and COIDA patient’s accounts to ensure accuracy of invoices with regard to ICD-10 codes, UPFS procedure codes and resource utilisation.
- Implement Case Management policies, protocols and procedures within the hospital.
- Assist with EDI rejections and provide quotations to privately funded and foreign patients and compile statistical reports.
- Supervise staff and liaise with relevant role players in matters relating to Case Management.
Note: This post will not be linked to any of the Occupational Specific Dispensations. No payment of any kind is required when applying for this post.
INSTRUCTIONS TO APPLICANTS: Z83 forms (obtainable from any Government department or www.westerncape.gov.za) must: Be completed in full, clearly reflect the name of the position, name and date of the publication (candidates may use this as reference), be signed, accompanied by a comprehensive CV, the names of 3 referees and certified copies of ID, driver’s licence and qualification/s. A separate application form must be completed for each post. Applications without the afore-mentioned will not be considered. Applications must be forwarded to the address as indicated on the advertisement.
No late, faxed or e-mailed applications will be accepted.
CV’s will not be returned. Excess personnel will receive preference. Applications, which are received after the closing date, will not be considered. Further communication will be limited to shortlisted candidates. If you have not received a response from the Department within 3 months of the closing date, please consider your application as unsuccessful. It will be expected of candidates to be available for selection interviews on a date, time and place as determined by the Department.
As directed by the Department of Public Service & Administration, applicants must note that further checks will be conducted once they are shortlisted and that their appointment is subject to positive outcomes on these checks, which include security clearance, qualification verification, criminal records, credit records and previous employment.
The Department of Health is guided by the principles of Employment Equity. Disabled candidates are encouraged to apply and an indication in this regard will be appreciated. This post was also advertised in the Argus/Burger 5/11/2015 and Southern Mail 9/12/2015.
Service benefits: 13th cheque, employer’s contribution to the pension fund, housing and medical aid allowance.
Salary: R 243 747 per annum.
Salary Level: Level 8
The Chief Executive Officer
Private Bag X02
(For attention: Ms N Fredericks)
Closing Date: 24 December 2015
Enquiries: Ms K Jackson
Tel: (021) 799-1290