- January 4, 2020
- Posted by: HIMAA
Part of the GMHBA Group, heath.com.au is an online Health Insurer based in hipster Abbotsford.
With tens of thousands of customers across Australia, the heart of our culture is a genuine desire to do the right thing and build the right experiences for our customers. That’s not something we simply say to sound honourable. It’s something we aim for every day.
We’re looking a full time Health Information Manager to join our team on a permanent basis. In this role you will review claims, both pre and post payment, to identify inaccuracies in billing and assist the Fund to ensure that health provider contracting achieves efficient and effective outcomes.
Responsibilities / Duties:
Working in a fast-paced environment you will have the skills, knowledge and experience to:
Assist in establishing policies, procedures, guidelines and audit schedules to assist in reducing claims leakage and ensure a standard approach to clinical claims coding and audit is followed.
Assist in establishing a database to enable interrogation of claims data to check validity and identify provider outlier claims.
Follow the identification of claim issues, provide education, support and subject matter expertise to relevant claims teams.
Consider problems or issues that may arise and use lateral thinking to resolve or recommend solutions
Ensure all audit functions are compliant with PHI Rules and Regulations, Australian Coding Standards, policy requirements, Fund Rules and health.com.au audit custom and practice.
Undertake the audit function according to an agreed audit schedule which includes priority focus areas, reviewed on a rolling twelve-month basis with the Commercial Manager.
Review and report on aggregated audit outcomes and trends and make recommendations from the analysis of claims for future contracting.
As required, participate in on-site hospital audits, reviewing clinical notes to confirm hospital billing as correct.
The successful candidate will ideally have:
A relevant qualification and experience working in capacity of Health Information Manager/Clinical Coder or proven professional experience in Australian Health Industry working in hospital billing.
High level competency with MS Office programs (word, outlook, excel).