CLINICAL AUDITOR at MEDICAL SCHEME

Ensuring that all claims and duties are performed within the agreed service levels with providers and that claims are efficiently and accurately processed.

Vet hospital accounts under the guidance of the gazette.

Use clinical guidelines and protocols when vetting accounts.

Daily auditing of captured accounts.

Align hospital accounts with authorisations on the system.

Checking accounts for non-chargeable items - as per the gazette.

Evaluation of accounts for technical correctness using sound medical judgement.

Reconcile hospital accounts.

Provide weekly reports.

Negotiate discounts with providers.

Reversal of claims and provide feedback to service providers.

Qualifications And Experience:

Registered or Enrolled Nurse.

SANC registration.

2-5 years clinical auditing experience.

Knowledge of ICD10 coding, modifiers, tariff codes.

Desired Skills:

• Registered or Enrolled Nurse.
• Clinical auditing of hospital accounts.
• Good knowledge of the medical aid industry.