Qualified Nurse required as Clinical Hospital Auditor for established company in managed healthcare.

Duties:

Delivering of cost-effective managed healthcare service to accomplish member satisfaction and to deliver affordable managed healthcare services.

Auditing of hospital accounts form R0 and above
Negotiations with hospitals regarding disputes and guidelines
Updating of the hospital audit guidelines
Constant and continuous gaining of experience and knowledge to ensure client satisfaction
Delivering a cost-effective managed healthcare service

Requirements:

Grade 12

B Cur degree/ Diploma in Nursing

5+ years’ experience as a nursing practitioner

and or 1+ years’ experience gained in the medical funding industry

Afrikaans and English - Bilingual ESSENTIAL

Understanding of the Medical Scheme Rules and Benefit Options.
Understanding of the medical scheme industry
Experience in the medical funding industry
Theatre and ICU experience

Knowledge/ Skills:

Thorough, well-grounded clinical knowledge of Pre Authorization of hospital admissions and Case Management of hospital cases in order to take cost-effective and appropriate decisions in evaluating treatment, LOS and LOC.
Knowledge of the current coding structures in the South African Health Care environment i.e. ICD10’s, CPT4, NRPL, and PMB conditions, protocols and Scheme rules

Salary:

R ctc per annum negotiable

(med aid + provident fund)
Yearly performance bonuses