File Assessor / Billing Auditor - Limpopo

Details of the offer

The Bill Auditor is responsible for auditing patient files to ensure completeness and accuracy of billing, while adhering to the National Hospital Network (NHN) rules and agreements with medical schemes. The role ensures that all billing processes are accurate, timely, and compliant with hospital and payer regulations. Duties will include but not be limited to: Print pro-forma invoices for allocated patient files Audit patient files according to company requirements and NHN agreements with medical schemes, including: Verifying the completeness of patient data (personal information, medical scheme details, admission and discharge dates) Reviewing eligibility tests, materials used, medications prescribed and administered Verifying surgical movements, theater minutes, prosthetics used, and equipment Ensuring Length of Stay (LOS) and Level of Care (LOC) matches medical scheme approvals Confirming the accuracy of admission types between the Hospital Information System (HIS) and patient files Document required corrections/amendments and escalate them to the Patient Administration Manager for resolution Verify corrections and process final billing on HIS after corrections are completed Perform End of Case (EOC) processes on MediKredit, investigating rejections, and resubmitting files when necessary For private patient claim files, finalize billing on HIS and forward to the Collections Department for further action Collaborate with Reception/Admissions, Case Management, Nursing, and Pharmacy staff to ensure accurate and timely final invoices Assist in minimizing delays and backlogs in the billing departmentFor paper claim files i.e. private patients (including COID and RAF patients), final bill the account on the HIS s as "paper" claim and forward patient files to the Collections Department for further management Complete, sign and file the Audit tool in the patients file Collaborate and build relationships with the with Reception/Admissions, Case Management, Nursing and Pharmacy staff to ensure that final invoices are generated without delays Requirements: Grade 12 or equivalent qualification Enrolled Nurse qualification Registered Nursing qualification 2 to 5 years of experience as a Bill Auditor/File Assessor, preferably in a private hospital setting Strong knowledge of National Hospital Network reimbursement models Proficiency in Hospital Information Systems (e.g., SAP or similar)


Nominal Salary: To be agreed

Source: Adzuna_Ppc

Requirements

Senior Desktop Support Technician

Our client, a leading ICT company based in Polokwane, is looking for a Desktop Support Technician who will be in the office or on site with corporate clients...


Network Recruitment - Limpopo

Published a month ago

Desktop Support Technician

· Install and configure PCs and software components for optimal usability.· Troubleshoot and resolve hardware and software issues.· Repair or replace damaged...


Recru-It - Limpopo

Published 24 days ago

Senior Desktop Support Technician

Qualifications & Requirements:3+ years' experience is Desktop support in a consulting environment.Educational Background: A Diploma or Degree in Information ...


Network Recruitment - Limpopo

Published a month ago

Administrator – Websites & Publications

The South African Subtropical Growers' Association (Subtrop) requires the services of an energetic person to:Manage/Maintain Websites and Apps of Subtrop and...


Subtrop - Limpopo

Published a month ago

Built at: 2024-11-08T20:00:39.436Z