Clinical Hospital Auditor - Pretoria Verfied

R 300K per annum Pretoria, Gauteng Pretoria, Gauteng more than 14 days ago 28-01-2015 2:56:07 PM
25-02-2015 2:56:07 PM
Description

Do you have a BCur Degree or Diploma in Nursing together with Hospital Case/ Claims Management experience? Then this is the position for you!
Our client in the managed healthcare industry is looking for an experienced and qualified Clinical Hospital Auditor to audit hospital accounts/ claims

Job Responsibilities:
Auditing of hospital accounts/ claims
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


Candidate Requirements

Minimum Requirements:(NOT NEGOTIABLE)
BCur Degree/ Diploma in Nursing
Minimum 1 year experience with hospital case management/ claims
Minimum 1 year experience working for a medical aid in a case management role
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


Skills and Experience Required:
Verbal, written and electronic communication with all Healthcare and Service Providers
Communication verbal and written to members and providers
Team communication on HBM policies and procedures
Medical Scheme Rules and Benefit Options correct interpretation
Clinical dispute resolution regarding hospital claims

Reports To: Department Manager