To manage and enhance the accuracy, compliance, and efficiency of billing operations at CHG, with a special focus on high-value cases. The Billings Quality Assessor is responsible for ensuring that all billing processes are executed accurately and adhere to regulatory standards, thereby reducing errors, rejections, and instances of underbilling by performing detailed and accurate audits of patient files comparing the products and services received by patients with the itemized bill.
Job Requirements: Diploma in General NursingCertificate in Clinical Coding (ICD-10) and CCSA5 Years overall work experience in medical billing and revenue cycle managementA strong understanding of laws, regulations, and industry best practicesProven experience in auditing claims for accuracy and complianceDuties and Responsibilities: Check and verify SAP reports daily for high-value cases, includingBilling status reports,Daily case management statistics,Released cases for final billing,Discharged not releasedVerifying patient personal information, Insurance Provider details admission and discharge date and timeVerifying materials (Ethical and Surgical) used by comparing with Prescription and Charge sheets in the file.Verifying that all medication prescribed, administered and returned to Pharmacy are reconciled accuratelyVerify that all invoices where Prosthesis, Consignment stock or high value pharmaceutical items were used were obtained and preauthorization and are included in the fileDocument corrections to patient files and make corrections on SAP System according to User`s Authorized SAP Access, if User doesn't have access refer corrections to relevant Departments.Conduct regular audits of billing records, focusing on high-value cases, ensuring compliance with local healthcare regulations, including the Medical Schemes Act and National Health ActAnalyse reports to identify negative trends and implement corrective actionsDevelop and implement quality assurance plans and procedures for billing processesAnalyse billing processes to identify areas for improvement to enhance accuracy and efficiencyFacilitate the investigation and resolution of billing-related issues, with a focus on preventing rejections and underbilling in high-value casesEngage proactively with Reception/Admissions, Case Management, Nursing and Pharmacy staff, where applicable, to ensure the least delay possible in ensuring invoices are final billedEnsure consistency in billing practices across CHG by promoting effective communication between departmentsReconcile billed amounts with payment receipts to ensure precise financial reporting and resolve any discrepanciesGenerate detailed reports on billing accuracy, compliance, and efficiency metrics, with special attention to high-value casesAssess and analyse information and reports to identify trends, discrepancies and inconsistencies for decision-making purposesClosing date for applications: 26 September 2024. Submit your CV and covering letter to ****** before the closing date. Only shortlisted candidates will be contacted for interviews. The company will appoint in line with the EE targets and recruitment policy, with internal employees considered first.
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