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 filesAudit 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 administeredVerifying surgical movements, theater minutes, prosthetics used, and equipmentEnsuring Length of Stay (LOS) and Level of Care (LOC) matches medical scheme approvalsConfirming the accuracy of admission types between the Hospital Information System (HIS) and patient filesDocument required corrections/amendments and escalate them to the Patient Administration Manager for resolutionVerify corrections and process final billing on HIS after corrections are completedPerform End of Case (EOC) processes on MediKredit, investigating rejections, and resubmitting files when necessaryFor private patient claim files, finalize billing on HIS and forward to the Collections Department for further actionCollaborate with Reception/Admissions, Case Management, Nursing, and Pharmacy staff to ensure accurate and timely final invoicesAssist 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 managementComplete, sign and file the Audit tool in the patients fileCollaborate and build relationships with the with Reception/Admissions, Case Management, Nursing and Pharmacy staff to ensure that final invoices are generated without delaysRequirements:Grade 12 or equivalent qualificationEnrolled Nurse qualificationRegistered Nursing qualification2 to 5 years of experience as a Bill Auditor/File Assessor, preferably in a private hospital settingStrong knowledge of National Hospital Network reimbursement modelsProficiency in Hospital Information Systems (e.g., SAP or similar)