The incumbent will be responsible in collaboration with hospital case management teams, for liaising between the patients, treating clinicians and managed care organisations in order to provide clinical coding that is updated in accordance with the patient response to treatment in order to receive reimbursement from funders.
- Demonstrate expertise in clinical coding and the DRG model and an understanding of the complex cause and effect factors within the broader managed care industry.
- Identify discrepancies, potential quality of care and billing issues. Utilisation Review
- Review and analyse clinical coding periodically during a patient event in relation to mapped clinical coding requirements.
- Continual assessment of work to ensure a continuous improvement in ICD-10 and CPT coding and collection of quality health data.
- Allocate clinical codes to patients’ current period of care using knowledge of the information contained within the International Classification of Diseases, revision 10, and CPT coding books.
- Communicate with funders about clinical coding errors and disputes.
- Conduct assessment of work to make sure that it is continuous improvement in ICD-10 and CPT coding and collection of quality health data.
- Assist with adhoc case management required at hospital level.
- Review of PMB queries and recommendations for action.
- Intermediate computer proficiency.
- ICD 10 coding and an understanding of coding standards.
- CPT coding and an understanding of coding standards
- Min of 3 years’ experience in Clinical Coding and or Case management in a hospital environment
Qualification & Experience:
- Diploma in Nursing or equivalent NQF level 6 qualification within healthcare sciences.
- Certificate in Advanced ICD-10.
- Certificate in Advanced Complete CPT for South Africa
- SANC registration as a Registered Nurse.
Vacancy Type: Full Time
Job Functions: N/A
Job Location: Johannesburg, Gauteng, SA
Application Deadline: N/A