Bill Auditor at Life Healthcare

Critical Outputs

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 Life 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
• Analyze & report trends on rejection
• Analyze & report trends on short payment report
• Analyse & report late charges
• Analyze & 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

• Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses.
• Current SANC registration appropriate to relevant Medical Qualification
• 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