Billing Operations Cluster BOC Case Manager

Billing Operations Cluster BOC Case Manager page is loaded## Billing Operations Cluster BOC Case Manager remote type:
Hybrid locations:
Billings Operation Centre COIDtime type:
Full time posted on:
Posted Todaytime left to apply:
End Date:
January 16, 2026 (3 days left to apply) job requisition :
JR103938
** 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.
** KEY WORK OUTPUT AND

ACCOUNTABILITIES DISRUPTIVE INNOVATIONClinical Risk Management
• 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.

Diagnostic and procedural coding
• 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.

Build and maintain stakeholder relationships
• Liaise with a network of internal and external stakeholders to ensure final billing.
• Develop collaborative relationships to help accomplish work goals.

Effective communication
• 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.

Legal compliance
• Compliance with all industry relevant legislative acts, regulations and circulars.
• Compliance with Group Policies, Procedures and Processes.

TRANSFORMATION OF OUR SOCIETYTraining and development
• 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.

Teamwork
• Actively participate as a member of a team to achieve goals.

Personal and professional development
• 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.

SKILLS PROFILEEDUCATIONRequired
• B Degree/Diploma Nursing qualification or equivalent NQF level 6.
• Enrolled nursing qualification or equivalent NQF level
4.Preferred
• Qualification in associated Healthcare Sciences or Managed Care/ Case Management.

WORK EXPERIENCE Required
• 3 years professional healthcare experience.
• General administrative skills.
• Computer literate.

KNOWLEDGE Required
• Clinical background.
• Understanding of a patients journey in the private healthcare environment from patient admission to final billing.

PHYSICAL REQUIREMENTS In the event of any physical or psychological limitation that may impair the employee’s ability to perform the required job function, the employee must consult the employer for reasonable accommodation.

VALUES AND BEHAVIOURSNetcare Values At Netcare, our core value is care. We care about the dignity of our patients and all members of the Netcare family. We care about the participation of our people and our partners in everything we do. We care…