Minimum Requirements
- degree in Nursing.
- 5-7 years experience as a Patient Services Manager.
- ICD-10 and CPT coding experience.
- Revenue Cycle Management experience.
- Develop and implement a Group Strategy on short-payment management to improve cashflow.
- Implement funder contracts pertaining to the revenue cycle and monitor compliance.
- Identify training needs for the revenue cycle department and provide training.
- Provide support to the Funder relations team as necessary.
- Ensure that new tariffs and billing rules are loaded accordingly on the approved system.
- Ensure the monitored addition of new CPT / ICD coding onto the CHG approved system.
- Assist in implementing relevant systems and modules at hospital levels.
- Monitor the EDI report to ensure all queries have been resolved and all cases are End Of Case.
- Provide support to PSMs at hospital level to ensure CHG standards and targets are met.
- Ensure compliance to Group working procedures and assist hospitals to develop hospital specific services areas.
- Ensure PSMs at hospital level provide adequate support to hospital managers to monitor and enforce the use of mobile billing.
- Review revenue (RPPD) and debtors days by analyzing reports received from Group Finance in terms of budget v actual revenue and address improvement opportunities with hospitals.
- In collaboration with relevant stakeholders, review services on SAP to ensure optimization of billings of services.
- Manage financial risk through:
- DRG profit analysis and reporting.
- Engagement with funders counterparts regarding disputes with regards to revenue cycle contractual agreements.
- Analyse data trends relating to rejections and short payments etc.
- Verification of clinical coding as per policies and procedures.
- Preparing and ensuring sound audit compliances to achieve optimum business ethics.
- Participating and developing action plans within the revenue management team
- Implement effective controls to ensure accurate billing by:
- Driving the accurate and business billing process to ensure Patient Services metric targets are achieved.
- Ensure accurate application and interpretation of specialized wards criteria.
