Clinical Auditor/senior Clinical Auditor

23 hours ago

Pretoria, 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 man-days 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.
- Follow-up 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 2 - 3 year tertiary qualification in a clinical or related discipline, with at least 2 - 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;
- ICD-10, 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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