Hospital Bill Auditor

SUMMARY:
Background:
Our Client in the Healthcare sector is looking for a Bill Auditor to manage the financial and clinical risks of the Business Unit

POSITION INFO:
Minimum Requirements:

• 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

• 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

• 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 Patient’s 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 Patient’s 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

• 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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• Please take note that the applicants who do not adhere to the minimum requirements will not be considered for the respective position.
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• If you have not received a response within two (2) weeks from applying, your application was then unsuccessful for that specific position, however your profile remains on our system for future opportunities.