A vacancy exists for a Bill Auditor based at Life Bedford Gardens Hospital reporting to the Patient Services Manager, Michelle Novaine. 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 a 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 where 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

Analyse & 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

 

Nursing Qualification, Professional Nurse with at least three years’ experience with proven case manager and clinical coding experience of at least 3 -5 years.

Must be registered with SANC

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

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

Self-management

 

Interested candidates can send their CV