A vacancy exists for a Bill Auditor based at Life Flora Hospital reporting to the Patient Services Manager, Trust Pandor. The successful candidate will be responsible for managing the financial and clinical risks of the business unit by conducting retrospective audits of patient documentation, in order to identify and highlight areas of weakness, recommend corrective action and monitor effective implementation thereof, in support of the company objectives and strategy.

Critical Outputs
Effective delivery of quality customer care
Evaluate data accuracy to identify deviations and make recommendations for corrective action and implement and monitor same
Analyse data trends relating to rejections, short payments and Edit accommodations
Develop and maintain sound relationships with internal customers to achieve co-operation & compliance with audit processes
Compile and maintain a Bill Audit file containing copies of the Edit accommodation reports, late charges and bill audit reports (per file) – all signed by PSM
Supply proof of completed bill audit reports with additional copies placed in patient files
Effective auditing of patient documentation
Audit pre-set number of files according to Life standards, in order to achieve monthly target
Verify the presence of a completed checklist on file
Verify presence of copies of patient ID and medical aid on file
Verify patient details on IMEDS
Verify presence of accurately completed and signed bed letter on file
Verify carrier code detail on IMEDS to correspond with patient medical aid card
Verify the presence primary and secondary ICD and CPT coding
Verify and align proof listing to charge sheet
Verify and confirm accuracy of billing
Verify accuracy of discharge dates corresponding to patient dates
Verify and confirm if the correct equipment was charged according to the patient’s procedure
Compare the prosthesis invoice to charges on IMEDS and verify presence of invoice on file
Verify correct billing of theatre gases, modifiers, stock & time
Verify correct billing of oxygen usage
Verify correct billing of ventilator charges
Complete a bill audit template on each file audited
Complete the bill audit toolkit and any updates were required
Successfully complete the LHC coding course and achieve a set pass rate
Analyse audit results and make recommendations
Compile and submit a monthly Bill Audit report
Effective auditing of hospital operational processes
Verify statistics on number of elective cases that went to the pre-admission clinic
Analyse & report trends on rejection
Analyse & report trends on short payment report
Analyse & report late charges
Analyze & report Edit accommodations
Effective monitoring of patient services process compliance
Analyse trends to identify deviations
Report on deviations and influence Stock Controllers & Billing Clerks through presentations and discussion in monthly RSRT meetings & bill audit reports; to drive process of corrective action
Monitor effectiveness of implementation of action plans

Requirements

Diploma or degree Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses.
Current SANC registration appropriate to relevant Medical Qualification
Knowledge of hospital patient services and billing processes
Knowledge and understanding of CPT/CCSA & ICD coding
Knowledge of funder contracts, scheme rules, exclusions and benefits
Knowledge or clear understanding of hospital industry and practices
Computer proficiency

Competencies

Attention to detail
Problem-solving, analysis and judgement
Verbal & written communication (including presentations)
Influencing skills
Personal integrity
Planning & organising
Ability to build relationships
Drive and energy
Process orientation
Independence
Conflict management

Please send your resume/CV