Job Description

An exceptional career opportunity is available with our client, a leader in the private medical hospital sector, who is seeking a Clinical Auditor to join their team based in Gatesville.Role Purpose The role is designed to support the improvement and management of cost-effective healthcare services. It involves optimizing healthcare delivery, ensuring that resources are used wisely. Minimizing unnecessary expenses while maintaining high standards of patient care and implementing strategies to contain and reduce the associated costs of these services. To ensure hospital documents especially Theatre sheets are audited timeously and accurately with the focus on reducing wastage and abuse, as well as to ensure that all hospital documentation is processed accordinglySkills:

• Teamwork
• Examining information
• Articulating information
• Upholding standards
• Accountability
• Attention to detail
• Time management

Responsibilities:Internal Process

• Apply clinical policies and protocols to funding.
• Ensure accurate notes are made for all clinical audits as well as claims.
• Ensure accurate completion of authorizations on audit finalization.
• Refer approval queries to department managers for resolution.
• Act as clinical support to non-clinical hospital clinical auditors in terms of hospital tariff applications and clinical guidance.
• Ensure correct application of tariff and discrepancies are forwarded to the relevant team.
• Review hospital dues for clinical appropriateness, treatment authorized, over-usage of equipment/materials.

Customer Service

• Investigate hospital queries within the agreed service level and ensure that the relevant stakeholder receives timeous feedback.
• Escalate queries to the relevant team or stakeholder.
• Provide accurate information and advice to stakeholders to ensure that they receive the appropriate service.
• Resolve auditing queries accurately and timeously.
• Build and maintain relationships with internal and external stakeholders.

People:

• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialization.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.
• Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

Finance

• Identify opportunities to enhance cost effectiveness and increase operational efficiency
• Manage financial and other company resources under your control with due respect

Requirements

• A National Senior Certificate is essential.
• It is essential to have a Nursing Diploma or Degree.
• The incumbent must be registered with the South African Nursing Council (SANC) as a Registered Nurse.
• Minimum of 2 yearsxe2x80x99 private hospital nursing experience.
• Previous exposure to clinical auditing is highly useful.
• Be available to work on site.

For more information please contact:Tersia Frantz

SD Recruitment