Bill Auditor

Function

Patient services

Facility

Life Flora Hospital

Position

Bill Auditor

Introduction

A vacancy exists for a Bill Auditor based at Life Flora Hospital, reporting to Gail Bunting, Patient Services Manager. The successful candidate will be responsible for managing the financial and clinical risks by reviewing claims, conducting audits of patient records and claims with regards to captured data on the LHC systems, billed items and contractual agreements. This person shall identify and highlight areas of non-compliance, manage, monitor, implement corrective action and assess the effectiveness of the corrective measures and report there on, in support of the company objectives and strategy.

Critical Outputs

Grow our business through improved utilisation of assets and enhanced return on investment

• Implementation, facilitation and sustainment of Patient Services initiatives / strategy projects.
• Manage compliance with all Policies & Work Procedures to minimize clinical, Reputational and financial Risk.
• Manage the working capital KPI’s related to IDSO’s, repricing errors, rejections and clawback on short payment management.
• Champion change, for the implementation of new growth strategies within the hospital
• Participating in and developing action plans within the risk management team.
• Liaison with Hospital Manco teams on funder requirements where necessary. 

Efficiency resulting in the delivery of improved cost-effective care

• Drive effective application and correct interpretation of all types of risk sharing reimbursement tariffs and contracts, funder rules and PMB’s (where applicable)
• Manage accuracy of accounts to Funders and implement corrective actions where identify.
• Ensure that the Life Healthcare Contracts are applied accurately to enable risk management.
• Effective auditing of hospital operational processes:
  • Evaluate data accuracy, identify deviations, implement corrective actions and monitor improvement and effectiveness of action plans.
  • Analyse and report on trends and influence the responsible parties to drive improvements on focus areas.
• Audit the completeness and accuracy of claims e.g. Data Governance, full event details, coding, billing, etc.
• Provide support for the management of clinical updates, repricing errors and rejections.
• Ensure compliance with the clinical code of conduct to ensure the accurate interpretation of a patient event.
• Reporting/monitoring/assisting with of all matters relating to case management:
  • Authorisation disputes
  • Internal DSO
  • Claim rejections
  • Claim disputes/short payments
  • PMB disputes.
  • Repricing Errors
• Implement and monitor the Patient Services workflow processes and available management reports related to the patient journey.
• Engagement with funders regarding disputes with regards to contractual agreements.
• RSRT and DRG profit/loss analysis and reporting.

Deliver high-quality care through continuous improvement in patient experience and clinical outcomes

• Comply with hospital closure of any non-compliance identified in the audits, review risks and ensure immediate closure of critical non-conformances.
• Support the PSM to manage and evaluate the effectiveness (IDSO’s) of agreed SLA’s (service level agreements) between the different functional areas – evaluate for effectiveness and suggest improvements to the process for the next financial year period (e.g., internal DSO’s).
• Report all non-conformances and support PSM to manage by performing root case analysis, trending and evaluation.
• Ensure targets achieved as per PS scorecard
• Assist with Quality Improvement where gaps have been identified from audits/complaints/trends.
• Management of Data Quality through Data Governance processes.
• Data Management process for the unit includes POPI/PAIA.
• Records management process to ensures the secure and compliant handling of documents throughout their lifecycle, including scanning, controlled destruction, long-term archiving, and adherence to regulatory and organisational standards.

Ensure long-term sustainability through appropriate investment and minimising our environmental impact while positively impacting the communities

• Management of stakeholder relationships internally and externally to promote strategy and efficiency by
• Develop and maintain collaborative relationships with internal stakeholders to achieve objectives.
• Manage Continuous Learning, optimise performance and Promote Quality Management Systems.
• Manage Patient Experience to ensure expectations are exceeded/met.

Requirements

• Nursing Qualification, Professional Nurse with at least three years’ experience, with proven case manager and clinical coding experience of at least 3 – 5 years.
• Current SANC registration appropriate to relevant Medical Qualification
• Knowledge of hospital patient services and billing processes and private hospital industry and practices
• Comprehensive knowledge and understanding of CPT & ICD coding
• Knowledge of Funder contracts, scheme rules, exclusions and benefits
• Computer proficiency
• Competency of related legislation e.g. National Health Act, Medical Schemes Act with regulations, Mental Healthcare Act.

Competencies

• Problem-solving, analysis and judgement
• Attention to detail
• Verbal and written communication skills and presentation skills
• Influencing and Independence
• Professional and technical proficiency
• Planning and organising
• Process orientation
• Interpersonal and relationship building skills
• Organisational awareness
• Excellence orientation
• Ethical behavior/integrity
• Resilience
• Drive and energy
• Self-management
• Personal integrity

Email

Flora.Recruitment@lifehealthcare.co.za

Closing date

Wednesday, May 20, 2026