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M&M Consulting Services and Talent Acquisition

Clinical Auditor: Hospital Claims at M&M Consulting

M&M Consulting Services and Talent Acquisition

  • R47,000 per month
  • Permanent Intermediate EE position
  • Bryanston
  • Posted 25 May 2024 by M&M Consulting Services and Talent Acquisition
  • Expires in 19 days
  • Job 2568751
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About the position

Key responsibilities

  • Vet hospital accounts under the guidance of the gazette
  • Use clinical guidelines and protocols when vetting accounts
  • Liaise with other members of the team and other departments
  • Daily auditing of captured accounts
  • Align hospital accounts with authorisation on system
  • Checking accounts for non- chargeable items - as per gazette
  • Evaluation of accounts for technical correctness using sound medical judgement
  • Reconcile hospital accounts
  • Deal with external auditors' queries regarding payment of hospital accounts
  • Involved with mapping of new tariffs, by identifying them & sending requests to IT
  • capturing /editing/auditing
  • Provide weekly reports to management
  • Investigate claims against daily reports
  • Capture authorisations on the IMED system
  • Handle member /hospital queries regarding hospital accounts payment
  • Schedule the weekly roster for the clinical auditors
  • Work with other healthcare personnel within the organisation
  • Provide clinical expertise within the organisation where required
  • Negotiation of discounts and credits with hospitals
  • Reversal of claims and provide feedback to service providers
  • Training of staff within the organisation

Desired Skills:

  • Nursing Diploma
  • 3 to 5 years (Assessing experience - Multiskilling between capturing /editing/auditing) Previous clinical auditing
  • ICD10 coding
  • Modifiers
  • tariff codes Audit reasons and decisions iMed and Cubed

Desired Work Experience:

  • 2 to 5 years External Auditing

Apply Now

M&M Consulting Services and Talent Acquisition

About the agency

M&M Consulting Services as a business was established by its owners through the passion and commitment in serving people and Corporates, by providing strategic partnerships to our clients, developing expertise of our client's environment, their challenges and other needs. With over 14years experience in Human Capital, M&M Consulting Services has mainly focused on Managed Services and Recruitment and allowing businesses to focus on their core business. We combine our HR expertise with the knowledge of our client's environment to design, implement and manage customized staffing solutions, resulting in improved business performance for our clients. M&M Consulting Services is a SME, providing the flexibility most companies desire in the current economical state. We are ever changing and by doing so,we are able to blend in with the land scape changes. WHAT WE DO Partnering with key Stakeholders, Our vision is to be a proudly South African talent solutions provider, delivering the highest quality of service to clients and candidates. We’re in the business of transformation, of both organizations and careers. Through the range of recruitment, talent management and recruitment process outsourcing solutions we offer, we help both organizations and individuals realize their full potential.

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