Diploma or Degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses
Current SANC registration appropriate to relevant medical qualification
Knowledge of the Life Bill Audit Toolkit, clinical coding
Life Case Manager Toolkit an advantage
Knowledge of hospital patient services and billing processes
Knowledge and understanding of CPT / CCSA & ICD coding
Knowledge or clear understanding of hospital industry and practices
Proficient on MS Office Suite
Responsibilities :
Evaluate data accuracy to identify deviations and make recommendations for corrective action and implement and monitor same
Analyse data trends relating to rejections, short payments and Edit accommodations
Develop and maintain sound relationships with internal customers to achieve co-operation & compliance with audit processes
Compile and maintain a bill audit file containing copies of the edit accommodation reports, late charges and bill audit reports (per file) all signed by PSM
Supply proof of completed bill audit reports with additional copies placed in patient files
Audit pre-set number of files according to Life standards, in order to achieve monthly target
Verify the following :
The presence of a completed checklist on file
The presence of copies of patient ID and medical aid on file
Patient details on IMEDS
The presence of accurately completed and signed bed letter on file
The carrier code detail on IMEDS to correspond with Patients medical aid card
The presence primary and secondary ICD and CPT coding
Verify and align proof listing to charge sheet
Verify and confirm accuracy of billing
The accuracy of discharge dates corresponding to patient dates
Verify and confirm if the correct equipment was charged according to the Patients procedure
Compare the prosthesis invoice to charges on IMEDS and verify presence of invoice on file
The correct billing of theatre gases, modifiers, stock & time
They correct billing of oxygen usage
The correct billing of ventilator charges
The statistics on number of elective cases that went to the pre-admission clinic
Complete a bill audit template on each file audited
Complete the bill audit toolkit and any updates were required
Successfully complete the LHC coding course and achieve a set pass rate
Analyse audit results and make recommendations
Compile and submit a monthly bill audit report
Analyse & report trends on rejection
Analyse & report trends on short payment report
Analyse & report late charges
Analyze & report Edit accommodations
Effective monitoring of patient services process compliance
Analyse trends to identify deviations
Report on deviations and influence Stock Controllers & Billing Clerks through presentations and discussion in monthly RSRT meetings & bill audit reports; to drive process of corrective action
Monitor effectiveness of implementation of action plans
TO APPLY :
Only if you meet the minimum job requirements and experience as mentioned above, you may submit a detailed updated CV.
Please Apply Online and complete your registration via our website to enable and protect you as a candidate and to accept the new POPIA terms and conditions.
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Auditor • Johannesburg, South Africa
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