En/rn with Hospital Claims Assessing

A reputable Medical Aid is seeking an experienced Hospital Claims Auditor to join their team in Bryanston. (SANC registered EN or RN)

**Duties**:

- Vetting hospital accounts under the guidance of the Gazette
- Using clinical guidelines and protocols when vetting accounts
- Liaising with other members of the team and other departments
- Daily auditing of captured accounts
- Aligning hospital accounts with authorisation on system
- Checking accounts for non-chargeable items as per the Gazette
- Evaluating accounts for technical correctness using sound medical judgement
- Reconciling hospital accounts
- Dealing with external Auditors’ queries regarding payment of hospital accounts
- Involved with mapping of new tariffs, by identifying them & sending requests to IT
- Capturing/editing/auditing
- Providing weekly reports to Management
- Investigating claims against daily reports
- Capturing authorisations on the IMED system
- Handling member/hospital queries regarding hospital accounts payment
- Scheduling the weekly roster for the clinical auditors
- Working with other Healthcare personnel within the organisation
- Providing clinical expertise within the organisation where required
- Negotiation of discounts and credits with hospitals
- Reversing claims and providing feedback to Service Providers
- Training staff within the organisation

**Requirements**:

- SANC Enrolled or Registered Nurse
- Hospital Claims assessing experience within a Medical Aid environment
- Knowledge of Tariff and Nappi codes, Modifier, Practice Types, ICD 10 codes.
- Good knowledge of the IMed/Cubed system
- 3-5 years Assessing experience
- Multiskilling between capturing /editing/auditing
- **Previous Clinical Auditing experience in a Managed Healthcare (Medical Aid administration) environment is essential**

**Job Types**: Full-time, Permanent

Pay: R1,00 - R2,00 per month

Application Question(s):

- What is your salary expectation (Before deductions)
- Are you available to work in office, on a daily basis, Monday-Friday? (Bryanston, JHB)

**Experience**:

- Hospital Account assessing/auditing: 2 years (required)

License/Certification:

- SANC (required)