Clinical Auditor RN
3 days ago
We are seeking a skilled Clinical Auditor to join our team at Headhunters. In this role, you will be responsible for ensuring that hospital claims are audited in a timely and accurate manner, with a focus on reducing wastage and abuse.
The ideal candidate will have a National Senior Certificate, a Nursing Diploma or Degree, and be registered with the South African Nursing Council as a Registered Nurse. They should also have a minimum of 2 years' private hospital nursing experience and previous exposure to clinical auditing.
The key responsibilities of this position include:
- Applying scheme rules, clinical policies and protocols to funding
- Actioning allocated hospital claims for audit within department KPIs and CMS requirements for claims payment
- Ensuring accurate notes are made for all journals actioned on claims audited
In addition to these responsibilities, the successful candidate will also be expected to:
- Assess prosthesis for PMB funding when benefits are exceeded or if there is no benefit
- Ensure accurate completion of authorisations on claim finalisation
- Refer LOC/LOS/item or drug approval queries to case managers for resolution
This is an excellent opportunity for a motivated and detail-oriented nurse to take their career to the next level. If you are passionate about healthcare and have a strong background in clinical auditing, we encourage you to apply for this exciting role.
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