A vacancy exists for a Bill Auditor based at Life Queenstown Private Hospital, reporting to the Administration Manager, Yandiswa Ntandani. 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 OutputsEffective delivery of quality customer careEvaluate 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 cooperation & 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 documentationAudit 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 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 of 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 processesVerify statistics on the number of elective cases that went to the pre-admission clinic.Analyze & report trends on rejection.Analyze & report trends on short payment report.Analyse & report late charges.Analyze & report Edit accommodations.Effective monitoring of patient services process complianceAnalyse 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.RequirementsNursing Qualification, preferably Professional Nurse with at least three years' experience or Enrolled Nurse with proven case manager and clinical coding experience of at least 3 -5 years.Current SANC registration appropriate to relevant Medical Qualification an advantage.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.CompetenciesAttention to detail.Problem-solving, analysis, and judgement.Verbal & written communication (including presentations).Influencing skills.Personal integrity.Planning & organizing.Ability to build relationships.Drive and energy.Process orientation.Independence.Conflict management.Self-management.Email: ******
Closing date: Monday, October 21, 2024
Internal applicants - Before making an application, you are requested to discuss your application with your line manager. External candidates will also be considered.
Life Healthcare is an Equal Opportunity Employer.
Thank you for your interest in this opportunity. Kindly note that only shortlisted candidates will be contacted. Applicants who have not been contacted within two weeks of the closing date of this advert should consider their application as unsuccessful.
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