Bill Auditor

1 week ago


Johannesburg, South Africa Cynbar Human Capital Full time

Effective delivery of quality customer care
- Evaluate data accuracy to identify deviations and make recommendations for corrective action and implement and monitor same
- Analyse data trends relating to rejections, short payments and Edit accommodations
- Develop and maintain sound relationships with internal customers to achieve co-operation & compliance with audit processes
- Compile and maintain a Bill Audit file containing copies of the Edit accommodation reports, late charges and bill audit reports (per file) all signed by PSM
- Supply proof of completed bill audit reports with additional copies placed in patient files

Effective auditing of patient documentation
- Audit pre-set number of files according to standards, in order to achieve monthly target
- Verify the presence of a completed checklist on file
- Verify presence of a copies of patient ID and medical aid on file
- Verify patient details on IMEDS
- Verify presence of accurately completed and signed bed letter on file
- Verify carrier code detail on IMEDS to correspond with patient medical aid card
- Verify the presence primary and secondary ICD and CPT coding
- Verify and align proof listing to charge sheet
- Verify and confirm accuracy of billing
- Verify accuracy of discharge dates corresponding to patient dates
- Verify and confirm if the correct equipment was charged according to the patients procedure
- Compare the prosthesis invoice to charges on IMEDS and verify presence of invoice on file
- Verify correct billing of theatre gases, modifiers, stock & time
- Verify correct billing of oxygen usage
- Verify correct billing of ventilator charges
- Complete a bill audit template on each file audited
- Complete the bill audit toolkit and any updates where required
- Successfully complete the LHC coding course and achieve a set pass rate
- Analyse audit results and make recommendations
- Compile and submit a monthly Bill Audit report

Effective auditing of hospital operational processes
- Verify statistics on number of elective cases that went to the pre-admission clinic
- Analyse & report trends on rejection
- Analyse & report trends on short payment report
- Analyse & report late charges
- Analyse & report Edit accommodations

Effective monitoring of patient services process compliance
- Analyse trends to identify deviations
- Report on deviations and influence Stock Controllers & Billing Clerks through presentations and discussion in monthly RSRT meetings & bill audit reports; to drive process of corrective action
- Monitor effectiveness of implementation of action plans

**Requirements**:

- Nursing Qualification, preferably Professional Nurse with at least three years experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -5 years.
- Current SANC registration appropriate to relevant Medical Qualification an advantage
- Knowledge of the Bill Audit Toolkit, clinical Coding and Case Manager Toolkit an advantage
- Knowledge of hospital patient services and billing processes
- Knowledge and understanding of CPT/CCSA & ICD coding
- Knowledge of funder contracts, scheme rules, exclusions and benefits
- Knowledge or clear understanding of hospital industry and practices
- Computer proficiency


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