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Accounting / Finance
- Contract
Medical Claims Clinical Auditor (ee)
Port Elizabeth
Monthly nursing experience.
- Apply scheme rules, clinical policies and protocols to funding.
- Action 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) relevant team.
- Review hospital claims for clinical appropriateness, treatment authorized, over-usage
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