claims assessing experience in the Medical Aid industry. Assess all claims using the appropriate rules and
claims assessing experience in the Medical Aid industry. Assess all claims using the appropriate rules and
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
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.
<
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
Performance Areas Audit & review medical bills. Analysis of claimed items/services in correlation with responsible for processing payments Auditing medical claims and assisting in technical aspects of bill Performance Areas Audit & review medical bills. Analysis of claimed items/services in correlation with responsible for processing payments Auditing medical claims and assisting in technical aspects of bill
Performance Areas Audit & review medical bills. Analysis of claimed items/services in correlation with responsible for processing payments Auditing medical claims and assisting in technical aspects of bill Performance Areas Audit & review medical bills. Analysis of claimed items/services in correlation with responsible for processing payments Auditing medical claims and assisting in technical aspects of bill
Credit Controller to assist with Private and medical aid claims. Implement credit control procedures for Psychiatry. Follow up with medical aids to ensure prompt payment of outstanding claims. Apply any necessary Advices (RA) Resolve rejections from medical aids and upfront claim rejections Submit paper claims when