Clinical Auditor RN

3 days ago


Port Elizabeth, Eastern Cape, South Africa Headhunters Full time

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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