A vacancy exists for a Bill Auditor based at Life Groenkloof Hospital reporting to the Patient Service Manager. 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

Requirements
Grade 12 National Senior Certificate
Nursing Qualification, preferably Professional Nurse with at least three years’ experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -5 years.
Current SANC registration appropriate to relevant Medical Qualification an advantage
Knowledge of the Life Bill Audit Toolkit, clinical Coding and Life Case Manager Toolkit an advantage
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

Competencies
Problem-solving, analysis and judgement
Resilience
Engaging diversity
Verbal & written communication and presentation
Influencing
Drive & energy
Excellence orientation
Ethical behaviour
Building relationships