Group Patient Services Manager

To take responsibility for overseeing the revenue cycle value chain from a Group perspective which includes identifying improvement opportunities to optimize billing to maximise revenue. This includes the reduction of the Groups financial risk by ensuring compliance and procedures including contractual arrangements with Medical Schemes/funders.

Minimum Requirements

• degree in Nursing.
• 5-7 years experience as a Patient Services Manager.
• ICD-10 and CPT coding experience.
• Revenue Cycle Management experience.

Minimum Work 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.