Job Title: Billings Auditor Location: Clinix Hospitals Reports to: Patient Services Manager Job Summary: To oversee the hospital's billings process and ensure products and services received by patients align with the Rand Value of the final bill. The incumbent performs detailed and accurate audits of patient files, comparing the products and services received with the itemized bill in the context of the Company's billing requirements and contractual arrangements with Medical Schemes.
Minimum Qualifications and Experience: Diploma in NursingFinance related qualification2-3 years of experience in a similar role and positionMinimum Job Requirements: Print pro-forma invoices on allocated patient filesAccess SAP reports daily, such as:Billing status reportReleased for final billingDischarged not releasedReview and analyze reports as a management tool, in order to identify negative trends and implement corrective actionEscalate trends and deviations to relevant Departments and follow up to ensure corrective action has been implementedConduct sample audits on patient files to assess accuracy and general quality of the work completed by the billings team; identify trends and deviations and implement corrective actionAudit patient files as per Company requirements and in accordance with the Company contracts with Medical Schemes:Verifying patient personal information, Medical Scheme details, admission and discharge date and timeVerification of medication usedVerifying medication prescribed, administered, and returned to the PharmacyVerifying surgical movement (where applicable), including gases and equipment used, theatre minutesVerifying LOS updates from Medical Schemes to ensure days allocated by Medical Schemes reconcile to actual LOSVerifying that the treatment category on SAP system reconciles with treatment category on patient fileDocument corrections to patient files and escalate to appropriate individuals as required / distribute to the relevant departmentsVerify corrections completed by Departments and accurately check the final bill on the systemPerform End of Case (EOC) on the approved systemEnsure the accurate maintenance of supplier invoicesSpecific to private patients (including COID and RAF patients), final bill invoices on the SAP system as "paper" claim and forward patient files to the Collections Department for further management
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