Role Purpose
The purpose of this temporary role is to ensure hospital claims are audited timeously and accurately with the focus on reducing wastage and abuse, as well as to ensure that claims are processed according to authorizations for a period of 6 months only.
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in the medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in and high-cost medication appropriateness. Customer Service: Investigate hospital claim queries within
in the medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in and high-cost medication appropriateness. Customer Service: Investigate hospital claim queries within
within the medical field. This role involves effectively handling patient accounts, insurance claims, and outstanding unpaid debt and the collection thereof for Medical Aid Claims and Private Patients Collection of outstanding traced for collection of debt Ensure that all medical aid claims are submitted within the regulated time frame write offs, medical aid stale claims and prescription of debt Debtor and Medical Aid Claim Liaison Communicate
explanation of variances. Revenue/Debtors Check all medical aid claims are loaded on Health Bridge and correctly correctly submitted. Call Medical Aid in respect of submitted claims and confirm status of claims. Follow-ups
explanation of variances. Revenue/Debtors Check all medical aid claims are loaded on Health Bridge and correctly correctly submitted. Call Medical Aid in respect of submitted claims and confirm status of claims. Follow-ups
appointments. Receive patients. Opening of files. Medical aid claims: Vericlaim / Medicharge. Processing ICD-10
Experience: At least 2 years' gap cover or medical claims experience Technical knowledge of various health
Experience: At least 2 years' gap cover or medical claims experience Technical knowledge of various health
requirements, and industry standards. Evaluate medical claims, escalations, pre-authorization requests, and requirements, and industry standards. Evaluate medical claims, escalations, pre-authorization requests, and