Clinical Auditor

at MVG Recruitment Specialists
Location Cape Town, South Africa
Date Posted
Category Healthcare
Job Type FULL_TIME
Work Hours Day
Salary Units MONTH

Description

Introduction
Managed Healthcare Corporate requires the services of a Clinical Auditor for their team.

To apply, please send CV with supporting documents Subject Line: REF: MVG/CAU

Supporting Documents:

– Copy of CV

– Copy of Matric

– Copy of Nursing Diploma

– Copy of Post Basic Qualification

– Copy of SANC Registration

 

 

Skills

Excellent knowledge of PMB legislation, hospital billing guidelines secures this exciting opportunity

Qualifications

Post Basic qualification in Theatre Operating Science or Critical Care (preferred)
Clinical post graduate experience of 3-5 years within Private Hospital Sector with at least 3 years experience in ICU or Theatre

Educational Requirements

Registered Nurse currently registered with SANC (4 year Diploma/ Degree)

Responsibilities

Reporting into the Team Leader, the successful incumbent will be responsible for the following:

To ensure Hospital Claims are audited timeously and accurately as per Service Level Agreements
Review and maintain clinical auditing rules annually
Review hospital network billing guidelines annually and relay feedback to the business
Review specific hospital claims for clinical appropriateness, treatment received and consistency within scheme rules, clinical policies and protocols
Identification of hospital trends and claiming patterns with the objective of changing provider behaviours
Provide clinical support to the provider network team
Attend quarterly HRM operational meetings to provide feedback on trends and application of billing guidelines
Assist with authorisation/ claim queries
Review of automated monthly savings reports

Experience Requirements

At least 3 years working experience as Clinical Auditor within a Managed Care environment