Job Description

Hospital Admin ManagerRequirements:

• Grade 12
• An applicable tertiary qualification will be an advantage
• A minimum 3 xe2x80x93 5 years Management or Supervisory experience
• Knowledge of ICD 10 and CPT Coding
• Knowledge of Medical Aid Rules and Fixed Fee Contracts with Funders
• In depth knowledge and understanding of Private Hospital Billings guidelines
• General accounting knowledge and financial skills
• Ability to work well under pressure and function independently
• Excellent computer skills

Key Outputs:

• Manage the Admin Department and processes with regards to non-releases
• Manage the Credit Control queries
• Manage Case Manager updates and escalations for Medical Aids
• Ensure accurate ICD 10 and CPT Coding
• Analysis of Billing errors
• Managing Fixed Fee Contracts with Medical Aids
• Management of staff
• Daily and Monthly reporting to Hospital Manager and Head Office regarding Admin stats
• Month end finalisation of files
• Private patientsxe2x80x99 quotations, Financial Risk Management and daily banking
• Auditing of Hospital folder greater than 10K
• Auditing coding on claims and checking if co-morbidities have been captured
• Auditing of clinical data submitted to the Medical funder / aid / institute
• Ensuring that the high cost medication process has been followed
• Responsible for the security and accuracy of the patient records
• Liaise with the relevant stakeholders regarding claims, billings etc. and ensure that all claims /queries have been actioned by the relevant staff members within the Department
• Oversee and streamline the billing processes
• Plan and implement quality assurance for all billing and case management processes
• Conduct routine staff meetings regarding billing planning and implementations
• Assist in standardising the methods in which work will be accomplished
• Ensure that the activities of the billing operations are conducted in a manner that is consistent

with overall department protocol and follow Melomed healthcare regulations, guidelines and
requirements, review departmental procedures and evaluate the effectiveness of personnel

• Understand and remain updated with current coding and billing regulations, compliance

requirements and scheme rules changes / requirements

• Provide, oversee, and/or coordinate the provision of training for new and existing staff on

applicable operating policies, protocols, systems and procedures, standards, and techniques

• Checking of daily reports
• Ward report xe2x80x93 ensure all patients are allocated to a Case Manager and updated accordingly
• Nonxe2x80x93Release - ensure all discharge folders are received
• Medikredit Control Panel - ensure all claims are accurate and submitted accordingly
• Checking daily Theatre slates
• Follow up on daily, weekly and monthly queries
• Assist staff members with escalation of claims, queries, billings and LOM requests

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