Clinical Auditor

About the position

A well-established company located in Johannesburg North is looking for a Clinical Auditor to join their team!
Minimum Education: Nursing Qualification (Nursing Diploma as a registered nurse)
 
Minimum Experience: 3 to 5 years (previous clinical auditing experience in a managed healthcare environment is essential)
  
Duties and Requirements includes but is not limited to the following:

• Knowledgeable of the Medical Schemes Act and Government Gazette on tariffs
• 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
• 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:

• Clinical Auditor
• Healthcare Audit Coordinator
• Quality Assurance Auditor
• Clinical Compliance Specialist
• Clinical Quality Control Specialist