Bill Auditor

LIFE Healthcare Group; Rustenburg; On-site; ZAR 300,000 - 400,000; Full time

Job summary

A leading healthcare provider is seeking a Bill Auditor at Life Peglerae Hospital. The candidate will manage financial and clinical risks through audits and evaluations. Requires a Nursing Qualification and experience in clinical coding. Opportunity to enhance patient services and compliance processes. Competitive application process and commitment to equal opportunity.

Qualifications

• At least three years of experience in a nursing role.
• 3-5 years of clinical coding experience.
• Understanding of CPT & ICD coding.

Responsibilities

• Manage financial and clinical risks by conducting audits.
• Evaluate data accuracy and implement corrective actions.
• Compile and submit monthly bill audit reports.

Skills

Clinical coding experience

Case management experience

Knowledge of hospital billing processes

Computer proficiency

Education

Grade 12 National Senior Certificate

Nursing Qualification, preferably Professional Nurse

Tools

iMeds / Impilo system

Job description

Overview

A vacancy exists for a Bill Auditor based at Life Peglerae Hospital reporting to the Patient Services Manager, Suzette van Rensburg.

The successful candidate will be responsible for managing the financial and clinical risks of the business unit by conducting retrospective audits of patient documentation, in order to identify and highlight areas of weakness, recommend corrective action and monitor effective implementation thereof, in support of the company objectives and strategy.

Responsibilities

• Effective delivery of quality customer care
• Evaluate data accuracy to identify deviations and make recommendations for corrective action, implement and monitor same
  • Analyse data trends relating to rejections and short payments etc.
  • Develop and maintain sound relationships with internal customers to achieve co-operation and compliance with audit processes
  • Compile and maintain a bill audit file containing copies of documentation as per LHC protocols
• Effective auditing of patient documentation
  • Audit pre-set number of files according to Life standards, in order to achieve monthly target
  • Complete a bill audit template on each file audited
  • Complete the relevant Toolkits and any updates where required
  • Complete, successfully, the LHC coding course and achieve a set pass rate
  • Analyse results and make recommendations
  • Compile and submit a monthly bill audit report, report in relevant meetings
• Effective auditing of hospital operational processes
  • Retrospective clinical auditing of claims and rejected accounts and active engagement with funders
  • Equipment invoicing auditing
  • Expedite the cash flow management
  • Redirect workflow to a single responsible party to manage the funder rejections and relieve case management effort
  • Refocus on formulary compliance and trends analysis on increased benefit limitations and protocols
• Effective monitoring of patient services process compliance
• Analyse trends to identify deviations, report on and influence Stock Controllers & Billing Clerks through presentations and discussions and training in monthly RSRT meetings & bill audit reports

Requirements

• Grade 12 National Senior Certificate; Nursing Qualification, preferably Professional Nurse with at least three years’ experience
• Clinical Coding experience of at least 3-5 years
• Case Management Experience
• Specialized units Nursing experience
• Knowledge of the iMeds / Impilo system will be beneficial
• Knowledge of hospital patient services and billing processes
• Knowledge and understanding of CPT & ICD coding
• Knowledge of Funder contracts, scheme rules, exclusions and benefits
• Knowledge or clear understanding of hospital industry and practices
• Computer proficiency

Competencies

• Grade 12 National Senior Certificate; Nursing Qualification, preferably Professional Nurse with at least three years’ experience
• Clinical Coding experience of at least 3-5 years
• Case Management Experience
• Specialized units Nursing experience
• Knowledge of the iMeds / Impilo system will be beneficial
• Knowledge of hospital patient services and billing processes
• Knowledge and understanding of CPT & ICD coding
• Knowledge of Funder contracts, scheme rules, exclusions and benefits
• Knowledge or clear understanding of hospital industry and practices
• Computer proficiency

Email: [e-mail]

Closing date: Friday, October 31, 2025

Internal applicants – Before making an application, you are requested to discuss your application with your line manager. External candidates will also be considered.

Life Healthcare is an Equal Opportunity Employer.

Thank you for your interest in this opportunity. Kindly note that only shortlisted candidates will be contacted. Applicants who have not been contacted within two weeks of the closing date of this advert, should consider their application as unsuccessful.