Billings auditor

Location: Clinix Naledi Nkanyezi Private Hospital (Sebokeng).

Reports to: Patient Services Manager.

To oversee the hospital’s billings process and ensure products and services received by patients aligns with the Rand Value of the final bill. The incumbent performs detailed and accurate audits of patient files, comparing the products and services received with the itemized bill in the context of the Company’s billing requirements and contractual arrangements with Medical Schemes.

• Nursing Diploma
• 2-3 years’ experience in Billings environment
• Advanced Computer Literacy
• SAP will be an advantage.

• Print pro-forma invoices on allocated patient files
• Access SAP reports daily, such as:
  • Billing status report
  • Released for final billing
  • Discharged not released
• Review and analyse reports as a management tool, in order to identify negative trends and implement corrective action
• Escalate trends and deviations to relevant Departments and follow up to ensure corrective action has been implemented
• Conduct sample audits on patient files to assess accuracy and general quality of the work completed by the billings team; identify trends and deviations and implement corrective action
• Audit patient files as per Company requirements (and standards) and in accordance with the Company contracts with Medical Schemes:
  • Verifying patient personal information, Medical Scheme details, admission and discharge date and time
  • Verification of medication used
  • Verifying medication prescribed, administered and returned to the Pharmacy
  • Verifying surgical movement (where applicable), including gases and equipment used, theatre minutes
  • Verifying LOS updates from Medical Schemes to ensure days allocated by Medical Schemes reconcile to actual LOS
  • Verifying that the treatment category on SAP system reconciles with treatment category on patient file
  • Document corrections to patient files and elevate to appropriate individuals as required / distribute to the relevant departments
  • Verify corrects completed by Departments and accurately check the final bill on the system
  • Perform End of Case (EOC) on the approved system
  • Ensure the accurate maintenance of supplier invoices
  • Specific to private patients (including COID and RAF patients), final bill invoices on the SAP system as “paper” claim and forward patient files to the Collections Department for further management