Clinical Auditor/senior Clinical Auditor

2 weeks ago


Pretoria, Gauteng, South Africa Careforce recruitment Full time
Our client, a medical aid scheme in Pretoria are currently looking for a
Clinical Auditor/Snr Clinical Auditor.

This is a full-time hybrid position, and it will be expected of the successful individual to work at the office at least 3 days a week.
About the role:
To conduct clinical/coding audits according to the established internal, IIA and ISACA standards.

Essential functions of the job:

  • Plan for the execution of clinical audits and adhering to approved budgeted mandays and timelines.
  • Execution of the audit steps according to internal/IIA/ISACA standards.
  • Perform ad hoc audits and consulting engagements as required.
  • Report on audit results according to Internal/IIA/ISACA standards.
  • Followup on previous findings.
  • Give inputs to the annual audit planning and the Audit & Risk Committee reporting.
  • Liaise with audit clients and other role players during audits and provide regular and timely feedback.
  • Liaise with Forensic Investigations, IT Audit & Operational Audit, and fellow auditors during the execution of an audit.
  • Promote good governance, risk management and internal control in the organisation.
  • Administration and record keeping of audits perform.
  • Keep Manager Clinical Audit informed of progress of audits.

Qualification and experience:

Paterson C3


Grade 12, with an appropriate - 3 year tertiary qualification in a clinical or related discipline, with at least - 4 years' experience in the healthcare industry or managed healthcare industry and/or clinical coding.

Paterson C4


Grade 12 with an appropriate 3 year tertiary qualification in a clinical or related discipline with at least 5 years' experience in the healthcare industry, including clinical auditing, pre-authorisation and/or case management and/or hospital benefit management.


Skills and knowledge:

  • Professional registration (clinical and / or internal auditing)
  • Computer literate MS Office.
  • Accuracy and attention to detail.
  • Quality orientated.
  • Analytical and investigative.
  • Assertive with good reporting skills.
  • Knowledge of the following:
  • Clinical auditing;
  • Funding protocols;
  • ICD10, CPT4 & NRPL coding structures;
  • PMB conditions;
  • Risk analyses;
  • Medical Scheme's Act;
  • King IV Reports; and
  • Revised COSO framework.

On offer:

Ability to commute/relocate:

  • Pretoria, Gauteng: Reliably commute or planning to relocate before starting work (required)

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