Billings Quality Assurance Specialist

2 months ago

Johannesburg, Gauteng, South Africa Ultra Personnel Full time
Job Summary:

To ensure the accuracy, compliance, and efficiency of billing operations, with a special focus on high-value cases. The Billings Quality Assessor is responsible for ensuring that all billing processes are executed accurately and adhere to regulatory standards, thereby reducing errors, rejections, and instances of underbilling by performing detailed and accurate audits of patient files comparing the products and services received by patients with the itemized bill.

Key Responsibilities:
  • Check and verify SAP reports daily for high-value cases, including billing status reports, daily case management statistics, released cases for final billing, discharged not released, and verifying patient personal information, Insurance Provider details admission and discharge date and time.
  • Verify materials used by comparing with Prescription and Charge sheets in the file, and reconcile accurately all medication prescribed, administered, and returned to Pharmacy.
  • Verify that all invoices where Prosthesis, Consignment stock or high value pharmaceutical items were used were obtained and preauthorization and are included in the file.
  • Document corrections to patient files and make corrections on SAP System according to User`s Authorized SAP Access, if User doesnt have access refer corrections to relevant Departments.
  • Conduct regular audits of billing records, focusing on high-value cases, ensuring compliance with local healthcare regulations, including the Medical Schemes Act and National Health Act.
  • Analyse reports to identify negative trends and implement corrective actions.
  • Develop and implement quality assurance plans and procedures for billing processes.
  • Facilitate the investigation and resolution of billing-related issues, with a focus on preventing rejections and underbilling in high-value cases.
  • Engage proactively with Reception/Admissions, Case Management, Nursing and Pharmacy staff, where applicable, to ensure the least delay possible in ensuring invoices are final billed.
  • Ensure consistency in billing practices across the group by promoting effective communication between departments.
  • Reconcile billed amounts with payment receipts to ensure precise financial reporting and resolve any discrepancies.
  • Generate detailed reports on billing accuracy, compliance, and efficiency metrics, with special attention to high-value cases.
Requirements:
  • Diploma in General Nursing
  • Certificate in Clinical Coding (ICD-10) and CCSA
  • 5 Years overall work experience in medical billing and revenue cycle management
  • A strong understanding of laws, regulations, and industry best practices
  • Proven experience in auditing claims for accuracy and compliance

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