Clinical Data Auditor
4 weeks ago
At Select One, we are seeking a highly skilled File Assessor to join our team. As a File Assessor, you will play a critical role in ensuring the accuracy and completeness of patient files, while adhering to the National Hospital Network (NHN) rules and agreements with medical schemes.
Key Responsibilities:- Print pro-forma invoices for allocated patient files
- Audit patient files according to company requirements and NHN agreements with medical schemes, including:
- Verifying the completeness of patient data (personal information, medical scheme details, admission and discharge dates)
- Reviewing eligibility tests, materials used, medications prescribed and administered
- Verifying surgical movements, theater minutes, prosthetics used, and equipment
- Ensuring Length of Stay (LOS) and Level of Care (LOC) matches medical scheme approvals
- Confirming the accuracy of admission types between the Hospital Information System (HIS) and patient files
- Document required corrections/amendments 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
- For private patient claim files, finalize billing on HIS and forward to the Collections Department for further action
- Collaborate with Reception/Admissions, Case Management, Nursing, and Pharmacy staff to ensure accurate and timely final invoices
- Assist in minimizing delays and backlogs in the billing department
- 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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