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Clinical Auditor Position at Medical Institution

2 weeks ago


Sandton, South Africa Middlesex College Full time

Job Description:

The clinical auditor will ensure that all claims and duties are performed within the agreed service levels with providers. This involves efficiently and accurately processing claims, vetting accounts under guidance, using clinical guidelines and protocols, and daily auditing of captured accounts.

Main Responsibilities:

  • Vet hospital accounts under the guidance of the gazette
  • Use clinical guidelines and protocols when vetting accounts
  • Daily auditing of captured accounts
  • Align hospital accounts with authorisations on the system
  • Checking accounts for non-chargeable items - as per the gazette
  • Evaluation of accounts for technical correctness using sound medical judgement
  • Reconcile hospital accounts
  • Provide weekly reports
  • Negotiate discounts with providers
  • Reversal of claims and provide feedback to service providers

Requirements:

  • Registered or enrolled nurse
  • SANC registration
  • 2-5 years clinical auditing experience
  • Knowledge of ICD10 coding, modifiers, tariff codes