Bill Auditor – Fixed Term Contract
Based at Life Head Office, reporting to National Clinical Review Manager. The successful candidate will manage financial and clinical risks by reviewing claims and conducting audits of patient records and claims related to captured data on the LHC systems, billed items and contractual agreements. They will identify areas of non‐compliance, implement corrective action, assess effectiveness and report on progress to achieve Life Healthcare objectives and strategy.
Critical Outputs
Management of financial risk includes:
* The interpretation and application of different reimbursement contracts.
* RSRT and DRG profit/loss analysis and reporting.
* Engagement with funders regarding disputes with regards to contractual agreements.
* Analyse data trends relating to rejections and short payments.
* Verification of clinical coding as per policies and procedures.
* Preparing and ensuring sound audit compliances to achieve optimum business ethics.
* Participating and developing action plans within the risk management team.
* Liaison with Hospital Manco teams on funder requirements where necessary.
* Interpretation and implementation of scheme benefit rules.
* Managing risk associated with ARM/RSRT's by developing system rules and training patient‐based data.
Ensure effective and accurate billing by:
* Driving the accurate and timely billing process to meet Patient Services metric targets.
* Ensuring accurate application and interpretation of FFS billing and accommodation rules.
* Reporting, monitoring and assisting with all matters relating to case management:
o Authorisation disputes
o Internal DSO
o Claim rejections
o Claim disputes or short payments
o PMB disputes
o Repricing errors
Management of stakeholder relationships internally and externally to promote strategy and efficiency by:
* Effective funder liaison, facilitating operational meetings and complaints management.
* Managing contractual obligations on SLA, TAT, ARMs.
* Developing and maintaining collaborative relationships with internal stakeholders to achieve objectives.
Effective auditing of hospital operational processes:
* Evaluating data accuracy, identifying deviations, implementing corrective actions and monitoring improvement.
* Analyzing and reporting on trends and influencing responsible parties to drive improvements.
* Monitoring compliance to business processes and effectiveness of action plans.
* Auditing the completeness and accuracy of claims (e.g., data governance, full event details, coding, billing).
* Providing support for the management of clinical updates, repricing errors and rejections.
* Ensuring compliance with the clinical code of conduct for accurate interpretation of a patient event.
Effective quality management and customer care by:
* Managing continuous learning, optimizing performance, and promoting quality management systems.
* Managing patient experience to ensure expectations are exceeded or met.
Requirements
* Nursing qualification, professional nurse with at least three years' experience, proven case manager and clinical coding experience of 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.
* Influencing and independence.
* Professional and technical proficiency.
* Interpersonal and relationship building skills.
* Organizational awareness.
* Excellence orientation.
* Ethical behaviour and integrity.
* Resilience.
Internal Applicants
Internal applicants are requested to discuss their application with their line manager before applying. External candidates will also be considered.
EEO Statement
Life Healthcare is an Equal Opportunity Employer.
Application Deadline and Contact
Email:
Closing date: Tuesday, February 24, 2026
Thank you for your interest in this opportunity. Only shortlisted candidates will be contacted. Applicants who are not contacted within two weeks of the closing date should consider their application unsuccessful.
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