Provide clinical inputs on ex-gratia funding requests Open, review and resolve all clinical queries and and assessments through providing a clinical decision or requesting more information where required Implement authorisation and claiming is facilitated Provide clinical training / support to identified stakeholders Knowledge and application of clinical principles and processes Knowledge of clinical and funding protocol development development Clinical research and assessment Knowledge of scheme rules and contractual negotiations Skill:
medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in Port Elizabeth hospital nursing experience. Previous exposure to clinical auditing is highly advantageous. Be available Responsibilities Internal Process: Apply scheme rules, clinical policies and protocols to funding. Action allocated case managers for resolution. Act as clinical support to non-clinical hospital claim auditors in terms of of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilization)
Provide clinical inputs on ex-gratia funding requests -Open, review and resolve all clinical queries queries and assessments through providing a clinical decision or requesting more information where required authorisation and claiming is facilitated -Provide clinical training / support to identified stakeholders -Knowledge and application of clinical principles and processes -Knowledge of clinical and funding protocol development development -Clinical research and assessment -Knowledge of scheme rules and contractual negotiations
Provide clinical inputs on ex-gratia funding requests -Open, review and resolve all clinical queries queries and assessments through providing a clinical decision or requesting more information where required authorisation and claiming is facilitated -Provide clinical training / support to identified stakeholders -Knowledge and application of clinical principles and processes -Knowledge of clinical and funding protocol development development -Clinical research and assessment -Knowledge of scheme rules and contractual negotiations
and Control; Clinical Facilitation Skills: Auditing and accreditation processes Clinical risk management
ensure coordinated patient care and participate in clinical meetings, ward rounds, and case discussions. Lead and data protection legislations. Participate in clinical audits, quality improvement (CPD) to stay updated related medical fields, with strong understanding of clinical practices. NHS salary and benefits package in
ensure coordinated patient care and participate in clinical meetings, ward rounds, and case discussions. Lead and data protection legislations. Participate in clinical audits, quality improvement (CPD) to stay updated related medical fields, with strong understanding of clinical practices. NHS salary and benefits package in
accounts. Reconciliations Daily reconciliation of all clinic receipts/banking (cash, yoco and medical aid receipts) reconciliations of pharmacy inventory for all clinics (inventory receipts, issues, and balances.) Weekly and allocations. Compile weekly report for each clinic on claim status. Weekly follow-up on medical aid
accounts. Reconciliations Daily reconciliation of all clinic receipts/banking (cash, yoco and medical aid receipts) reconciliations of pharmacy inventory for all clinics (inventory receipts, issues, and balances.) Weekly and allocations. Compile weekly report for each clinic on claim status. Weekly follow-up on medical aid
staff. The role requires strong leadership skills, clinical expertise, and a commitment to excellence in mental years of demonstrated leadership experience Strong clinical assessment and critical thinking skills Excellent conducive to patient recovery and well-being: Clinical Leadership Team Management Patient Care Coordination