CASE ADMINISTRATOR - CASE MANAGEMENT

PURPOSE OF POSITION

The Case Administrator provides administrative and financial support to the Case Management function, ensuring patient cases are accurately managed from admission through to discharge and account submission. The role ensures medical-aid information, authorisations, clinical updates and account documentation are followed up timeously, contributing to accurate billing, reduced claim rejections, improved cash flow and effective debtor management.

KEY PERFORMANCE AREAS

• Obtain and verify medical-aid membership, benefits and required pre-authorizations.
• Follow up outstanding authorizations, extensions and funding requirements.
• Assist with daily patient-in-progress reporting and ensure required documentation is obtained.
• Follow up outstanding clinical and administrative information required for account finalization.
• Ensure patient accounts are complete and identify information that may result in claim rejection or payment delays.
• Liaise with Billing, Bill Audit and Case Management regarding outstanding account requirements and billing queries.
• Monitor medical-aid claim rejections and queries and obtain information required for resolution.
• Monitor patients who remain in hospital, including long-stay and high-value cases, and ensure funding information is current.
• Maintain accurate case-management records and reports and ensure information is captured timeously.
• Adhere to hospital policies, medical-scheme requirements, confidentiality standards and agreed turnaround times.

MINIMUM REQUIREMENTS

• Grade 12 / Matric.
• Previous experience in a private hospital, medical-aid, healthcare administration, billing or case-management environment.
• Knowledge of medical-aid processes and hospital patient administration.
• Understanding of authorizations, medical-aid benefits and funding requirements.
• Basic understanding of hospital billing and account submission processes.
• Computer literacy, including Microsoft Office.
• Experience with hospital information systems would be advantageous.

NB: Only short-listed candidates will be contacted.
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By applying to this advert, you consent to JMH (Pty) Ltd collecting and processing your personal information for the purpose of determining your eligibility for the advertised position.
If unsuccessful, your personal information is securely destroyed and is not retained by the company.
Preference will be given to employees from the designated group in line with the Employment Equity Act.