Clinical Audits Support Analyst

The opportunity: We’re looking for a Clinical Audits Support Analyst to help the Clinical Audits Team reduce non-compliant hospital benefit outlay through strategic claims leakage prevention. In this role, you’ll be undertaking hospital contract compliance activities (including the conduct and management of onsite and desktop provider audits); and validating provider billing practices
Regular interstate travel may be required.
This is a permanent role, that can be based in Melbourne, Brisbane or Sydney We offer hybrid work arrangements, so you’ll have the flexibility to work from home when you aren’t visiting sites or working from the office in the Melbourne/Brisbane/Sydney CBD
To be successful in this role, you’ll need to have:

• Clinical Coding qualifications.
• Experience in healthcare auditing, preferably within a hospital or health insurance setting OR a minimum of three years’ experience in hospital claims assessing and reviews.
• An understanding of clinical coding impacts upon Diagnostic Related Groups (DRGs).
• An understanding of national, state and territory coding guidelines within Australia.
• An understanding of Hospital Purchaser Provider Agreement contracts and relationship to claims.
• Proven experience in data report writing and interpretation.

How will I help? You will add value by:

• Supporting the initiation and management of desktop and onsite audits, providing coding advice where appropriate.
• Providing clinical coding/claims advice to determine if further investigation and action is warranted, and expertise to identify areas of actual and potential claims leakage because of non-compliant clinical coding.
• Reviewing the specific detail of hospital claims to advise where there are incorrect or inappropriate ICD or ACHI coding/ billing practices.
• Contributing to achievement of business targets and financial measures under the direction of the Clinical Audits Lead and Hospital and Medical Integrity Manager.
• Supporting and assisting the Clinical Audits Team with administrative and operational tasks.
• Ensuring legal and regulatory compliance, adherence to internal operating procedures together with the management of business risks.

Why work at Bupa? A career at Bupa is more than just a job. It’s an opportunity to make a real difference in the lives of our customers and communities. Our purpose, helping people live longer, healthier, happier lives and making a better world, is what inspires us. It’s a promise to our customers to change lives, and our world, for the better. Our people are at the heart of this. It’s their passion, ideas and commitment that will shape a brighter future for both Bupa and our customers We’ve evolved from being simply a health insurer to what we call a ‘health and care’ company. This involves providing more wide-ranging services to benefit people’s health and wellbeing, wherever they are in life If you’ve got the belief, the energy, and the talent, come and join us
To learn more about working at Bupa please visit our website: www.bupa.com.au/careers
Bupa is an equal opportunity employer. We are committed to ensuring equality in recruitment, development, retention, and promotion of staff and that no-one is disadvantaged based on their gender, cultural background, disability, sexual orientation or identity, or Aboriginal and Torres Strait Islander heritage. We encourage people from all backgrounds to apply. If you require any adjustments to participate in our recruitment process, please let us know at the time of your application.