Job Requirements
Minimum educational qualification: Appropriate three-year health related National Diploma/Degree registrable with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANC). Experience: Appropriate experience in Case Management/Medical Aid Environment and Managed Health Care policies and protocols. Appropriate experience in ICD- 10 diagnostic and procedural code assignment. Competencies (knowledge/skills): Knowledge of Uniform Patient Fee Schedule, ICD-10 and the Medical Schemes Act 131 of 1998 and Regulations i.e. (PMB Legislation). Knowledge of EDI (Electronic Data Interchange), Managed Health Care standards and patient billing. To monitor the quality and ensure accuracy of Diagnostic and Procedural Coding. Computer Literacy (MS Word/Excel). Good communication skills (verbal and written).
Duties
Efficiently and effectively communicate and update clinical information for externally funded patients as well as the evaluation and monitoring of ICD 10- Coding for externally funded patients. Perform hospital Case Management functions w.r.t. pre-authorisation and authorisation, benefit management, and review of clinical information for externally funded clients as well as providing quotes for elective procedures. Identify PMB diagnosis or ICD-Code to ensure claims are paid from the correct benefit, as well as when benefits are exhausted. Efficient and effective interpretation and implementation of Case Management policies, protocols, and procedures including the conducting of clinical audits pf patient accounts to ensure accuracy of invoices for the submission to external funders. Supervision of staff as well as co-ordinating 171 the workflow processes between clinical and admin personnel relating to Case management which include ICD10-coding, PMB’s and account queries as well as quality client care and compilation of statistical reports for hospital management. Provide assistance to Hospital Fees staff regarding medical scheme authorisations, liaising with medical schemes and MediKredit regarding rejected claims as well as in terms of follow-up of outstanding medical scheme and state department balances, account queries and provide quotations to H2, H3 and Foreign patients.
What is the Salary
R397 116 per annum
Location
George Regional Hospital
How to Apply
www.westerncape.gov.za/health-jobs
Apply Before:
30 January 2026
ReferenceNo:
Additional Information
No payment of any kind is required when applying for this post. Shortlisted candidates may be subjected to a practical. The pool of applications will be considered for vacancies within George Hospital, for a period of three months from the date of the advert, provided that the job title, core functions, inherent requirements, and salary level are the same as those of the advertised post.