Clinical Auditor - North Johannesburg
Fusion Recruitment
Reference: JHB004856-Dom-1 A well-established company located in Johannesburg North is looking for a Clinical Auditor to join their team Minimum Education: Nursing Qualification (Nursing Diploma as a registered nurse) Minimum Experience: 3 to 5 years (previous clinical auditing experience in a managed healthcare environment is essential ) Duties and Requirements includes but is not limited to the following: Knowledgeable of the Medical Schemes Act and Government Gazette on tariffs Vet hospital accounts under the guidance of the gazette Use clinical guidelines and protocols when vetting accounts Liaise with other members of the team and other departments Daily auditing of captured accounts Align hospital accounts with authorisation on system Checking accounts for non- chargeable items - as per gazette Evaluation of accounts for technical correctness using sound medical judgement Reconcile hospital accounts Deal with external auditors' queries regarding payment of hospital accounts Involved with mapping of new tariffs, by identifying them & sending requests to IT Provide weekly reports to management Investigate claims against daily reports Capture authorisations on the IMED system Handle member /hospital queries regarding hospital accounts payment Schedule the weekly roster for the clinical auditors Work with other healthcare personnel within the organisation Provide clinical expertise within the organisation where required Negotiation of discounts and credits with hospitals Reversal of claims and provide feedback to service providers Training of staff within the organisation R 44 000 - R 48 000 - Monthly
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