Clinical Hospital Auditor: Ensure Accurate Claims & Care

Bestmed Medical Scheme; Gauteng; On-site; ZAR 350,000 - 550,000; Full time

Benefits offered by this job

23 days annual leave

8 hour workday (incl. 30 min lunch)

Life cover

Disability benefits

Funeral cover

Pension fund

Medical aid

Training and development opportunities

On-site gym

Wellness programme

Job summary

Bestmed Medical Scheme in Gauteng is seeking a Clinical Hospital Auditor HBM to audit hospital claims and related clinical information, ensuring correct benefit funding and compliance with scheme rules and contracts. You will also help manage healthcare expenditure and liaise with case management for pre-authorization.

The successful candidate should have a Grade 12, a B Cur degree or Nursing Diploma, at least 5 years as a nursing practitioner, 2 years in medical funding, and active SANC

Qualifications

• Grade 12
• B Cur degree or Diploma in Nursing/Enrolled Nurse
• Minimum 5 years' experience as a nursing practitioner
• Minimum 2 years' experience gained in the medical funding industry
• Active SANC Membership

Responsibilities

• Audit hospital claims and related clinical information to ensure appropriate benefit funding
• Verify that diagnoses, treatments and outcomes are clearly recorded
• Detect overbilling
• Reimburse clients for services rendered when proof is provided
• Identify gaps in quality of care and recommend improvements
• Apply prosthesis limit and reject short fall as per scheme rules
• Check funding guidelines to ensure claims are paid correctly and liaise with team members

Job description

Bestmed Medical Scheme in Gauteng is seeking a Clinical Hospital Auditor HBM to audit hospital claims and related clinical information, ensuring correct benefit funding and compliance with scheme rules and contracts. You will also help manage healthcare expenditure and liaise with case management for pre-authorization.

The successful candidate should have a Grade 12, a B Cur degree or Nursing Diploma, at least 5 years as a nursing practitioner, 2 years in medical funding, and active SANC