File Auditor

4 weeks ago

Polokwane, Limpopo, South Africa Select One Full time
Job Summary

The Bill Compliance Specialist is responsible for ensuring the accuracy and completeness of patient billing data. This involves auditing patient files to verify that all billing processes are accurate, timely, and compliant with hospital and payer regulations.

Key Responsibilities
  • Verify the completeness of patient data, including personal information, medical scheme details, and admission and discharge dates.
  • Review eligibility tests, materials used, medications prescribed and administered.
  • Verify surgical movements, theater minutes, prosthetics used, and equipment.
  • Ensure Length of Stay (LOS) and Level of Care (LOC) matches medical scheme approvals.
  • Confirm the accuracy of admission types between the Hospital Information System (HIS) and patient files.
  • Document required corrections and escalate them to the Patient Administration Manager for resolution.
  • Verify corrections and process final billing on HIS after corrections are completed.
  • Perform End of Case (EOC) processes on MediKredit, investigating rejections, and resubmitting files when necessary.
  • Collaborate with Reception/Admissions, Case Management, Nursing, and Pharmacy staff to ensure accurate and timely final invoices.

Requirements
  • Grade 12 or equivalent qualification.
  • Enrolled Nurse qualification.
  • Registered Nursing qualification.
  • 2 to 5 years of experience as a Bill Auditor/File Assessor, preferably in a private hospital setting.
  • Strong knowledge of National Hospital Network reimbursement models.
  • Proficiency in Hospital Information Systems (e.g., SAP or similar).

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