SUMMARY:
Private hospital group requires a Billings Analyst who holds a Diploma in General Nursing and has 3 to 5 years overall work experience in medical billing and revenue cycle management
POSITION INFO:
Job Summary:
To manage and enhance the accuracy, compliance, and efficiency of billing operations, with a special focus on high-value cases. The Billings Quality Assessor is responsible for ensuring that all billing processes are executed accurately and adhere to regulatory standards, thereby reducing errors, rejections, and instances of underbilling by performing detailed and accurate audits of patient files comparing the products and services received by patients with the itemized bill.
Job Requirements:
Diploma in General Nursing
Certificate in Clinical Coding (ICD-10) and CCSA
5 Years overall work experience in medical billing and revenue cycle management
A strong understanding of laws, regulations, and industry best practices
Proven experience in auditing claims for accuracy and compliance
Duties and Responsibilities:
Check and verify SAP reports daily for high-value cases, including:
Billing status reports,
Daily case management statistics,
Released cases for final billing,
Discharged not released
Verifying patient personal information, Insurance Provider details admission and discharge date and time
Verifying materials (Ethical and Surgical) used by comparing with Prescription and Charge sheets in the file.
Verifying that all medication prescribed, administered and returned to Pharmacy are reconciled accurately
Verify that all invoices where Prosthesis, Consignment stock or high value pharmaceutical items were used were obtained and preauthorization and are included in the file
Document corrections to patient files and make corrections on SAP System according to User`s Authorized SAP Access, if User doesn’t have access refer corrections to relevant Departments.
Conduct regular audits of billing records, focusing on high-value cases, ensuring compliance with local healthcare regulations, including the Medical Schemes Act and National Health Act
Analyse reports to identify negative trends and implement corrective actions
Develop and implement quality assurance plans and procedures for billing processes
Analyse billing processes to identify areas for improvement to enhance accuracy and efficiency
Facilitate the investigation and resolution of billing-related issues, with a focus on preventing rejections and underbilling in high-value cases
Engage proactively with Reception/Admissions, Case Management, Nursing and Pharmacy staff, where applicable, to ensure the least delay possible in ensuring invoices are final billed
Ensure consistency in billing practices across the group by promoting effective communication between departments
Reconcile billed amounts with payment receipts to ensure precise financial reporting and resolve any discrepancies
Generate detailed reports on billing accuracy, compliance, and efficiency metrics, with special attention to high-value cases
Assess and analyse information and reports to identify trends, discrepancies and inconsistencies for decision-making purposes
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