Clinical Auditor at Melomed Private Hospitals

• Review clinical documentation and billing to ensure accuracy, compliance, and proper coding against medical and legal standards. Their responsibilities include identifying discrepancies, auditing hospital accounts, ensuring correct tariffs and authorisations are applied, and maintaining a quality improvement cycle to uphold patient care standards.

Job Description

• Compilation of patient files to ensure that all relevant documents including documents on admission are in the file.
• Auditing patient files to ensure that all stock including consignment stock and services i.e. surgical, ethical, equipment, oxygen, theatre gases and tariffs are billed by actual usage and within the NHN guide.
• Auditing of patient files and verification of data i.e. Admission and Discharge Dates, membership options and dependent codes are correct. Daily Billing of Oxygen, Modifiers and Ventilators.
• Auditing of long stay In Patients Auditing of patient files to ensure that billing is according to the NHN guide and Melomed Billings Policies and Procedures.
• Ensuring that files are received and audited timeously and sent to the relevant departments to maintain the target of final billing files within 3 Days.
• Following up and resolving queries to ensure that the targets are maintained.
• Application of clinical knowledge in reviewing ICD and CPT coding of patient accounts. Compilation of reports for over and under billing.
• Adherence to deadlines.
• Administrative tasks.
• Adhoc and administrative duties as requested by line Manager.
• Filing.
• Ability to stay abreast of industry trends and knowledge.
• Keep up to date and compliance with Melomed’s Policies and Procedures.
• Maintain and sustain working key internal and external relationships

Job Requirements
Core Competencies:

Education:

• Grade 12 or equivalent NQF4 qualification
• Enrolled Nurse registered with South African Nursing Council
• Certificate in ICD 10 and CPT Coding

Experience:

• Minimum 3 years relevant experience in a multidisciplinary hospital

Knowledge & Skills:

• Computer Literacy
• Strong Administrative Skills Knowledge of Fixed Fees, per Diems and Alternate Reimbursement Models
• Knowledge of applicable statutory acts such as Consumer Protection Act; PMB; POPIA, etc.
• Excellent communication skills (written and spoken)