Clinical Auditor

The position of Specialist Clinical Auditor is available for a registered nurse (note: this is NOT a financial Auditor position). Permanent Position. The candidate must be a registered nurse with a valid registration with the SANC. Financial background working in the financial department of a hospital is a crucial requirement. Minimum 2 years experience within a private hospital's account department responsible for raising accounts and billing medical schemes.

Sound knowledge of the South African Health Care Industry and legislation, coding structures and protocols.

Thorough knowledge of pre-authorisation, case management and billing of hospital admissions.

Reponsibilities Include (but Not Limited To)

Auditing of hospital's accounts within the SLA's for contracted medical schemes

Communication to service providers on disputed items

Interact with medical advisors and clinical manager for clinical advice

Identify and comunicate trends on fraud, waste and abuse

Apply authorisation criteria such as level of care, clinical protocols etc.

Apply tariff criteria such as PMB legislation, tariff guidelines and billing policies

Perform audits of medical records to identify incomplete documentation or errors and neglect in patient care

Ensure hospital and clinic policies and procedures are followed by staff