Clinical Auditor Port Elizabeth - Gqeberha - Hire Power Recruitment

    Hire Power Recruitment
    Hire Power Recruitment Gqeberha

    2 weeks ago

    Default job background
    Description

    Registered Nurse - Clinical Auditor

    The hiring organisation offers a minimum six-month fixed term contract opportunity to an experienced Registered Nurse with private hospital nursing experience. Ideally you will be based in Port Elizabeth, EC but the possibility exists of a candidate being based in Durban, Bellville or Centurion.

    Roles and Responsibilities

    • Apply scheme rules, clinical policies and protocols to funding.
    • Action allocated hospital claims for audit within department KPIs and CMS requirements for claims payment.
    • Ensure accurate notes are made for all journals actioned on claims audited.
    • Assess prosthesis for PMB funding when benefits are exceeded or if there is no benefit.
    • Ensure accurate completion of authorisations on claim finalisation.
    • Refer LOC/LOS/item or drug approval queries to case managers for resolution.
    • Act as clinical support to non-clinical hospital claim auditors in terms of hospital tariff applications and clinical guidance e.g. procedures, devices and drug utilisation.
    • Survey claims for correct application of tariff and refer discrepancies to the relevant team.
    • Review retrospective claim approvals and send journal instructions for additional payments to the relevant team.
    • Review hospital claims for clinical appropriateness treatment authorised over-usage of equipment/materials application of billing rules and high-cost medication appropriateness.

    Customer Service

    • Investigate hospital claim 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 claim queries accurately and timeously.
    • Build and maintain relationships with internal and external stakeholders.
    • Reduce claim rejections to ensure members are not held liable for unnecessary costs.

    People

    • Build strong relationships through expressing positive expectations.
    • Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.
    • 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.

    Finance

    • Identify opportunities to enhance cost effectiveness and increase operational efficiency.
    • Manage financial and other company resources under your control with due respect.
    • Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

    Qualifications and Experience

    • Matric essential.
    • Completed Nursing Diploma or Degree essential.
    • The incumbent must be registered with the South African Nursing Council SANC as a Registered Nurse.
    • MS Office / Office 365 proficiency.
    • Fluent in English – essential requirement.
    • Open to SA citizens with a clear criminal and credit history.
    • Valid unendorsed Driver's License with own vehicle preferred.
    • Minimum of 2 years' private hospital nursing experience.
    • Previous exposure to clinical auditing is highly advantageous.

    Important Attributes

    • Teamwork.
    • Examining information interrogate claims data.
    • Articulating information.
    • Upholding standards.
    • Accountability.
    • Attention to detail.
    • Time management.

    Location: Port Elizabeth or Bellville Durban or Centurion.
    Profile: Healthcare Services.
    Career Level: 2+ years.
    Employment: Contract – six Month FTC.
    E.E. / Non-EE: Strictly EE ACI male or female.
    Working Hours: Monday to Friday. 08H00 – 17H00.
    Remuneration: Market related CTC basic.

    Short listed candidates may be expected to complete and pass assessments before moving to the next stage of the recruitment process.
    Should you not be contacted within two weeks please consider your application unsuccessful.

    #J-18808-Ljbffr
  • Drake International

    Leasing Manager Port Elizabeth,Port Elizabeth

    19 hours ago

    Drake International Gqeberha

    Job Title: Leasing Division Head · A dynamic and experienced individual is sought to lead the leasing division, driving sustainable growth for a leading retail brand in South Africa. · The successful candidate will be a skilled negotiator able to secure long-term leases for franc ...

  • Drake International

    General Manager Port Elizabeth,Port Elizabeth

    1 week ago

    Drake International Gqeberha

    Management Role in Cycling Industry · The Drake International client is a well-established national wholesaler and distributor of premium cycling brands to the South African market. · Headquartered in Gqeberha, this company requires a qualified individual to oversee its entire So ...

  • Headhunters

    Bookkeeper – Port Elizabeth

    1 week ago

    Headhunters Gqeberha

    Description · Our client, operating in the Aviation Industry, seeks an experienced Bookkeeper based in Port Elizabeth. · Key Requirements: · A minimum of 3-5 years' experience in a bookkeeping or accounting role is preferred. · Proficiency in Microsoft Office and accounting softw ...

  • EnableSA T/A EnableSA Pty Ltd

    Developer Port Elizabeth

    1 week ago

    EnableSA T/A EnableSA Pty Ltd Gqeberha

    Job Title: BPA Developer · Our global client seeks an experienced Business Process Automation (BPA) developer to join the team in Port Elizabeth. · Key Responsibilities · Design, develop, test and implement software solutions that meet company standards. · Provide internal and ex ...

  • Oza Holdings

    Geologist Port Elizabeth

    1 week ago

    Oza Holdings Gqeberha

    Job Title: Geologist · Job Summary: · We are seeking an experienced Geologist to study the composition, structure, and formation of limestone deposits. The successful candidate will be responsible for identifying potential limestone reserves, assessing their quality and quantity, ...

  • Headhunters

    Specialist Port Elizabeth

    1 week ago

    Headhunters Gqeberha

    Furnace Specialist · Job Description: · A career opportunity awaits an experienced Furnace Specialist to join our team. · Duties & Responsibilities · Requirements: · Matric (Maths and Science advantageous) · At least 3 years furnace experience · Computer literacy (Microsoft Offic ...

  • OUTsurance

    Broker (Port Elizabeth)

    1 week ago

    OUTsurance Gqeberha

    About OUTsurance · We are a customer-centric and dynamic financial services company with a global footprint and a proud history of innovation. Our vibrant, successful, and values-oriented culture is encapsulated by the ethos that clients and staff "always get something OUT." · As ...

  • Headhunters

    Paralegal – Port Elizabeth

    1 week ago

    Headhunters Gqeberha

    Job Summary · The ideal candidate will possess a strong passion for the legal field, excellent communication skills, and the ability to handle confidential information with integrity. · This is an exciting opportunity to grow your legal career in a reputable and fast-paced law fi ...

  • Fidelity Services Group

    Billing Clerk – Port Elizabeth

    1 week ago

    Fidelity Services Group Gqeberha

    **Job Title:** Billing Clerk – Port Elizabeth · **Location:** Eastern Cape, Port Elizabeth · **Key Responsibilities:Process instructions from sales orders, memos, and emails to bill new contracts for branches. · Manage stock/billing/credit notes related to inventory. · Generate, ...

  • EnableSA T/A EnableSA Pty Ltd

    Senior Analyst Port Elizabeth

    1 week ago

    EnableSA T/A EnableSA Pty Ltd Gqeberha

    Senior WMS Analyst · We are seeking an experienced Senior WMS Analyst to join our team in Port Elizabeth. · Key Responsibilities · Develop business requirements for WMS software upgrades and system configuration. · Implement and provide WMS support across applicable facilities. · ...

  • EnableSA T/A EnableSA Pty Ltd

    Office Manager Port Elizabeth

    1 week ago

    EnableSA T/A EnableSA Pty Ltd Gqeberha

    Job Title: Officer Manager · We seek an experienced professional to lead our Port Elizabeth team as Officer Manager. · Key Responsibilities · Supervise administration staff, including debtors, creditors, reception, and wage personnel. · Oversight of building structures and furnis ...

  • EnableSA T/A EnableSA Pty Ltd

    Payroll Administrator Port Elizabeth

    1 week ago

    EnableSA T/A EnableSA Pty Ltd Gqeberha

    Key Role: Payroll Administrator · We are seeking an experienced and skilled Payroll Administrator to join our team in Port Elizabeth. · Main Responsibilities: · Manage payroll administration for a portfolio of 40-50 clients, ensuring accurate and timely processing. · Respond to c ...

  • Rainmaker Acquisiton CC

    Associate Consultant Port Elizabeth

    2 weeks ago

    Rainmaker Acquisiton CC Gqeberha

    Job Summary · This position requires a skilled individual to perform outbound calls for confirmation of cover and other questions related to new proposal applications. The successful candidate will have excellent communication skills, the ability to work effectively under pressur ...

  • Fidelity Services Group

    Billing Clerk – Port Elizabeth

    1 week ago

    Fidelity Services Group Port Elizabeth Full time

    Job Title: Billing Clerk – Port Elizabeth · Summarized Job Description: · This role is responsible for managing billing processes, ensuring accurate and timely invoicing, and providing administrative support to the Credit Controllers team. · Key Responsibilities: · Process and lo ...

  • Headhunters

    Php Developer Port Elizabeth

    1 week ago

    Headhunters Gqeberha

    Experienced Intermediate PHP Developer Wanted · We are seeking a skilled and ambitious PHP developer to join our team in Port Elizabeth. · About the Role · This is an exciting opportunity for a talented individual with at least 3 years of experience in PHP development. · Main Res ...

  • Headhunters

    Software Developer Port Elizabeth

    4 days ago

    Headhunters Gqeberha

    Intermediate Software Developer (Office Based) · Our client in the IT industry based in Port Elizabeth is currently looking to employ an Intermediate Developer who will work on software development lifecycle including requirements capture, design, implementation, testing, install ...

  • Mirna Butler Recruitment

    Branch Manager, Port Elizabeth

    6 days ago

    Mirna Butler Recruitment Port Elizabeth

    Job Title: Branch Manager · We are seeking a results-driven Branch Manager to oversee operations, drive profitability, and ensure seamless service delivery across multiple locations in Port Elizabeth. · The successful candidate will be responsible for: · Leading and managing bran ...

  • Immploy Recruitment Agency

    Service Manager Port Elizabeth

    1 week ago

    Immploy Recruitment Agency Gqeberha

    Services Manager Position · A key role exists for a Services Manager within our organization at a Private Hospital Group in Port Elizabeth, reporting directly to the Hospital Manager. The successful candidate will be responsible for efficiently coordinating and managing internal ...

  • Hire Power Recruitment

    Creative Specialist Port Elizabeth

    1 week ago

    Hire Power Recruitment Gqeberha

    Creative Marketing Specialist · Job Overview: We are seeking a Creative Marketing Specialist with expertise in graphic design, content creation, social media management, and strategic marketing. The ideal candidate will have experience in creating compelling marketing materials a ...

  • Hire Power Recruitment

    Manager Education Port Elizabeth

    1 week ago

    Hire Power Recruitment Gqeberha

    PURPOSE OF THE POSITION · The organisation is a science-based organisation working to protect Africa's seas and communities for the benefit of all who live on the continent. Its mission is to empower individuals, organisations, and communities to become passionate, involved, and ...

Jobs
>
Port Elizabeth