Bill Auditor - Randfontein

Effective delivery of quality customer care

• Evaluate 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 co-operation & 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 documentation

• Audit pre-set number of files according to standards, in order to achieve monthly target
• Verify the presence of a completed checklist on file
• Verify presence of a 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 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 processes

• Verify statistics on number of elective cases that went to the pre-admission clinic
• Analyse & report trends on rejection
• Analyse & report trends on short payment report
• Analyse & report late charges
• Analyse & report Edit accommodations

Effective monitoring of patient services process compliance

• Analyse 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

 Requirements

• Nursing 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 Bill Audit Toolkit, clinical Coding and 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