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Clinical Auditor

Full Time

Website Melomed Private Hospitals

The Melomed Group consists of five private hospitals that are easily accessible to the majority of the population of the Western Cape and KZN namely: Melomed Gatesville, Melomed Mitchells Plain, Melomed Bellville, Melomed Tokai and Melomed Richards Bay; including a specialised mental health life-skills establishment in Claremont, 24 hour emergency centres, in-house pharmacies, Renal Dialysis Units, Cardiac Units, Nuclear Medicine, Oncology Units, Breast Clinic and Specialised ICU as well as an Emergency Ambulance Service.

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

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

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