Bill Auditor Job Dunkeld West Gauteng South Africa,Healthcare

Position: Bill Auditor | Fixed Term Contract
Location: Dunkeld West

Function Patient services Facility Position Bill Auditor | Fixed Term Contract Introduction

A vacancy exists for a Bill Auditor - Fixed Term Contract based at Life Head Office
, reporting to National Clinical Review Manager
. The successful candidate will be responsible for managing the financial and clinical risks by reviewing claims, conducting audits of patient records and claims with regards to captured data on the LHC systems, billed items and contractual agreements. This person shall identify and highlight areas of non-compliance, manage, monitor, implement corrective action and assess the effectiveness of the corrective measures and report there on, to achieve the Life Healthcare objectives and strategy.

Critical

Outputs

Management of financial risk by

The interpretation and application of different reimbursement contracts.

RSRT and DRG profit/loss analysis and reporting.

Engagement with funders regarding disputes with regards to contractual agreements.

Analyse data trends relating to rejections and short payments etc.

Verification of clinical coding as per policies and procedures.

Preparing and ensuring sound audit compliances to achieve optimum business ethics.

Participating and developing action plans within the risk management team.

Liaison with Hospital Manco teams on funder requirements where necessary.

Interpretation and implementation of scheme benefit rules.

Managing risk associated with ARM/RSRT’s by developing system rules and training patient-based data.

Ensure effective and accurate billing by

Driving the accurate and timeous billing process to ensure Patient Services metric targets are achieved.

Ensures accurate application and interpretation of FFS billing and Accommodation rules.

Reporting/monitoring/assisting with of all matters relating to case management:
Authorisation disputes Internal DSO Claim rejections Claim disputes/short payments PMB disputes. Repricing Errors

Management of stakeholder’s relationships internally and externally to promote strategy and efficiency by

Effective Funder liaison, facilitating operational meetings and complaints management.

Manage Contractual obligations on SLA, TAT, ARMs.

Develop and maintain collaborative relationships with internal stakeholders to achieve objectives.

Effective auditing of hospital operational processes

Evaluate data accuracy, identify deviations, implement corrective actions and monitor improvement.

Analyse and report on trends and influence the responsible parties to drive improvements on focus areas.

Monitor compliance to busine processes and effectiveness of action plans.

Audit the completeness and accuracy of claims Data Governance, full event details, coding, billing, etc.

Provide support for the management of clinical updates, repricing errors and rejections.

Ensure compliance with the clinical code of conduct to ensure the accurate interpretation of a patient event.

Effective quality management and customer care by

Manage Continuous Learning, Optimise performance and Promote Quality Management Systems.

Manage Patient Experience to ensure expectations are exceeded/met.

Requirements

Nursing Qualification, Professional Nurse with at least three years’ experience, with proven case manager and clinical coding experience of at least 3 – 5 years.

Current SANC registration appropriate to relevant Medical Qualification

Knowledge of hospital patient services and billing processes and private hospital industry and practices

Comprehensive knowledge and understanding of CPT & ICD coding

Knowledge of Funder contracts, scheme rules, exclusions and benefits

Computer proficiency

Competency of related legislation National Health Act, Medical Schemes Act with regulations, Mental Healthcare Act.

Competencies

Problem-solving, analysis and judgement

Attention to detail

Verbal and written communication skills

Influencing and Independence

Professional and technical proficiency

Interpersonal and relationship building skill

Organisational awareness

Excellence orientation

Ethical behavior/integrity

Resilience


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