Clinical auditor

Position Purpose: To audit, authorise and process the accurate payment of hospital and case management claims. Ensuring that patient treatment, material and equipment usage for each claim is in accordance with claim rules and regulations.

Experience: 3 – 4 years Manage Care experience, of which a minimum of 2 years should have been in a hospital pre-authorisation call centre.

Qualifications: Registered nurse diploma or degree (MANDATORY REQUIREMENT ) KEY PERFORMANCE AREAS

Client service delivery and quality Follow procedures and cooperate with peers and leader for best possible service delivery

Compliance and Risk Management Defined legal, statutory and regulatory compliance is maintained at the required standards Operational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary Contribute to cost savings within the department to assist with financial goals and targets C...