About the position
Ensuring that all claims and duties are performed within the agreed service levels with providers and that claims are efficiently and acurately processed. Qualifications and experience
Vet hospital accounts under the guidance of the gazette
Use clinical suidelines and protocols when vetting accounts
Daily auditing of captured accounts
Align hospital accounts with authorisations on the system
Checking acount for non-charable items - as per the gazette
Evaluation of accounts for technical correctness using sound medical judgement
Reconcile hospital accounts
Provide weekly reports
Negotiate discounts with providers
Reversal of claims and provide feedback to sevice providers
registered or enrolled nurse
SANC registration
2-5 years clinical auditing experience
Knowledge of ICD10 coding, modifiers, tariff codes
Desired Skills:
- registered or enrolled nurse
- clinical auditing of hospital accounts
- good knowledge of the medical aid industry
