Specialized Case Manager

About the role

The Life Eugene Marais Hospital is seeking a Specialized Case Manager to join the Patient Services team. Reporting to the Patient Services Manager, the role focuses on managing financial and clinical risk for patients in general wards by ensuring accurate coding, clinical updates, and timely account submissions.

Key responsibilities

• Conduct ward rounds and collect complete clinical data from patient files.
• Update clinical information to justify length of stay and level of care for medical funders.
• Provide funders with information on high‑value items, limited benefits, and protocol compliance.
• Communicate funder requirements to clinicians and patients, ensuring adherence to industry standards.
• Manage real‑time and manual messaging, including requests, responses, rejections, and submissions.
• Submit accurate accounts to funders and comply with governance, risk, and service‑level agreements.
• Ensure correct coding of patient accounts and proper interpretation of RSRT contracts and FFS claims.
• Escalate non‑compliance issues and maintain relationships with internal and external stakeholders.

Required profile

• Grade 12 National Senior Certificate.
• Diploma or degree in Nursing, Physiotherapy, Clinical Management or a related health discipline.
• Experience in clinical documentation, medical coding, or revenue cycle management is preferred.

Required skills

• Medical coding
• Clinical documentation
• Revenue cycle management
• Interpretation of RSRT contracts
• FFS claim processing