/>Minimum Experience: 3 to 5 years (previous clinical auditing experience in a managed healthcare environment under the guidance of the gazette
private medical hospital sector, who is seeking a Clinical Auditor to join their team based in Gatesville Apply clinical policies and protocols to funding. Ensure accurate notes are made for all clinical audits managers for resolution. Act as clinical support to non-clinical hospital clinical auditors in terms of hospital hospital tariff applications and clinical guidance. Ensure correct application of tariff and discrepancies to the relevant team. Review hospital dues for clinical appropriateness, treatment authorized, over-usage
private medical hospital sector, who is seeking a Clinical Auditor to join their team based in Gatesville Apply clinical policies and protocols to funding. Ensure accurate notes are made for all clinical audits managers for resolution. Act as clinical support to non-clinical hospital clinical auditors in terms of hospital hospital tariff applications and clinical guidance. Ensure correct application of tariff and discrepancies to the relevant team. Review hospital dues for clinical appropriateness, treatment authorized, over-usage
nursing experience.
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)
Clinical Risk Management Specialist Industry: Insurance Location: Cape Town Type: Hybrid (3 In/ 2 Out) seeks to employ a Clinically qualified individual to assist within their Clinical Risk Management team with clients to address risk profiles. Provide clinical leadership and support. Analyze research data the relevant council. Proven underwriting and clinical risk management working experience within Managed
Clinical Risk Management Specialist Industry: Insurance Location: Cape Town Type: Hybrid (3 In/ 2 Out) seeks to employ a Clinically qualified individual to assist within their Clinical Risk Management team with clients to address risk profiles. Provide clinical leadership and support. Analyze research data the relevant council. Proven underwriting and clinical risk management working experience within Managed
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)
Oversee appointment scheduling processes to optimize clinic workflow and resource utilization
Oversee appointment scheduling processes to optimize clinic workflow and resource utilization Billing and Insurance Interdepartmental Collaboration: Collaborate with clinical, financial, and IT departments to streamline processes