Purpose of the Job
The Hospital Audit Department performs clinical auditing for all hospital accounts in order to ensure that the hospital account has been billed in terms of the agreement with the hospital group, the medical Scheme’s rules and the authorisations provided in terms of the Hospital Utilisation Management service.
Duties and Responsibilities
- Validates member and hospital details.
- Applies Scheme rules to hospital accounts.
- Applies clinical protocols to hospital accounts.
- Has a good working knowledge of ICD10 codes.
- Has a good knowledge of medication used in a hospital.
- Has a good knowledge of consumables used in theatre and wards.
- Scrutinises the account to ensure that all charges are appropriate and valid.
- Identifies non-chargeable items and overcharges on the account.
- Liaises with the Scheme Medical Advisor or hospital.
- Completes special assignments and projects instrumental to the function of the department.
- Performs other duties as needed.
Required profile for job ad : Clinical Auditor - Windhoek
Experience and Qualifications Required
- Grade 12 / Namibia Senior Secondary Certificate (NSSC).
- Registered/ Professional Nurse.
- Minimum of 3 - 5 years’ experience in claims auditing within a medical scheme or managed care environment.
- Experience within the private hospital billing and accounts departments would be an advantage.
- Understanding of the healthcare industry and the use of medical scheme /healthcare financing terminology.
Skills and Competencies Required
- Strong verbal and written communications skills.
- Attention to detail.
- Customer service focus.
- Ability to work in a team environment.
- Ability to solve problems in a customer friendly manner.
Language Requirements
- Ability to speak and write English fluently.
- Ability to speak and write another language would be an advantage.
Registration Requirements
- Current and continued registration with the HPCNA.
Work Requirements
- The position is based in Namibia.
- Willingness to work long hours when required.
