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Smith Garb & Associates
Isando / Jet Park
The successful incumbent will have a completed B.Com (Accounting) degree or similar, as well as completed Articles, coupled with a minimum of 3 years Plant Financial Management experience within the FMCG / Manufacturing sector . Experience in dealing with retailers with regards to their rebates and claims as well as working knowledge of cost acco
Job Source: Smith Garb & AssociatesSmith Garb & Associates
Isando / Jet Park
A qualified CA(SA) or CIMA candidate is essential for the role, coupled with a minimum of 5+ years related experience as a Commercial Financial Manager within the FMCG or Cosmetics Manufacturing industries . KPI's include: General: Support the business in developing strategy, objectives, and goals; Lead the annual budgeting process; Lead the mon
Job Source: Smith Garb & AssociatesRBUK Legal Limited
, Noordwes
Experience: 2 - 4 years of experience required Job Type: Full Time Position Description A highly regarded and successful law firm based in Greater Manchester/Cheshire is seeking an experienced Clinical/Medical Negligence Solicitor to join their team. This is an exciting opportunity for a Solicitor with a minimum of 2 years' experience in handling a
Job Source: RBUK Legal LimitedPaton Personnel
CapeTown
Play active role influencing growth strategy. Commercial and Financial analytical skills required. This role is for someone with a curious mind and keen interest in solving the problem on hand. If you have not received a response in 2 weeks, please consider your application unsuccessful.
Job Source: Paton PersonnelJob Crystal
, Noordwes
These jobs were popular with other job seekers Internal Auditor- IT - North West Embark on a transformative journey with NWK, an organization at the forefront of innovation and excellence. We are actively seeking a distinguished professional to join our esteemed Assurance Services Department in the capacity of Audit Senior, responsible for IT audit
Job Source: Job CrystalElite Audit
, Noordwes
Elite Audit recruitment are working with an award-winning company in seeking an Internal Auditor to join their fast-growing Audit and Compliance team based in Chester. Reporting to our Group Head of Risk & Compliance, you will work closely with their Risk & Compliance Manager, creating and managing annual audit plans, conducting planned and ad hoc
Job Source: Elite AuditStatus Staffing
Portelizabeth
A recent professional profile photo is to accompany your application EMPLOYMENT TYPEÂ Â :Â Â Â Â Â Â Â Â Â Â Permanent SECTORÂ Â Â Â Â Â Â Â Â Â Â Â Â :Â Â Â Â Â Â Â Â Â Â Insurance BASIC SALARYÂ Â Â Â Â Â Â :Â Â Â Â Â Â Â Â Â Â Market Related START DATEÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â :Â Â Â Â Â Â Â Â Â Â A.S.A.P / Imme
Job Source: Status StaffingPaton Personnel
CapeTown
BI experience a bonus. Take full responsibility in developing business cases and train junior staff on BI solutions. 5 years working experience building models and a bachelors degree in actuarial science, commerce, or engineering as required. SQL , PowerBI or similar Should you not receive a response within two weeks of applying, please consider yo
Job Source: Paton PersonnelPortelizabeth
R Monthly
Role Purpose
The purpose of this temporary role is to ensure hospital claims are audited timeously and accurately with the focus on reducing wastage and abuse, as well as to ensure that claims are processed according to authorizations for a period of 6 months only.
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.
MS Office / Office 365 proficiency.
Minimum of 2 years private hospital nursing experience.
Previous exposure to clinical auditing is highly advantageous.
Be available to work at one of our offices based in Richmond Hill (Gqeberha), Cornubia (Durban), Bellville (Cape Town) or Centurion
Responsibilities
Internal Process:
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 authorizations on claim finalization.
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 utilization).
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 authorized, 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 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.
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.
Competencies:
Teamwork
Examining information (interrogate claims data)
Articulating information
Upholding standards
Accountability
Attention to detail
Time management
Please consider your application unsuccessful if you are not contacted within two weeks of applying.
Email Alert for Medical Claims Clinical Auditor (EE) jobs in Portelizabeth
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