Health Information Manager/ Clinical Coding Analyst

The opportunity: We’re looking for a Health Information Manager/Clinical Coding Analyst to reduce non-compliant hospital benefit outlay through strategic claims leakage prevention. In this role, you’ll be undertaking hospital benefit contract compliance activities (including the conduct and management of onsite and desktop provider audits); improving system rules, and validating provider billing and coding practices 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. Regular interstate travel may be required
To be successful in this role, you’ll need to have:

• Tertiary qualifications in health information management (preferred) or clinical coding.
• Extensive work experience gained in healthcare auditing, preferably within a hospital or health insurance setting, conducting compliance investigations, hospital or claims audits (essential).
• Advanced clinical coding experience, and a practical understanding of their impacts on Diagnosis Related Groups (essential).
• An understanding of clinical coding impacts upon Diagnosis Related Groups (DRGs).
• An understanding of hospital casemix concepts in the Private Health Insurance setting.
• Experience working within the Private Health Insurance industry.
• Understanding of private hospital contract management practices and concepts.
• 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:

• Arranging and conducting regular onsite and desktop provider audits, manage end to end processes including follow up and financial management of incorrect billing.
• Validating provider initiated DRG review requests based on coding and documentation analysis.
• Initiating, managing and finalising hospital, clinical, provider, and member profiling reviews within an agreed annual work program.
• Reviewing the specific detail of hospital and medical claims to advise where there are incorrect or inappropriate coding/billing practices.
• Providing clinical/coding standards advice on statistical reports produced by Data and Claims Analysts to determine if further investigation and action is warranted.
• Initiating, writing, developing, and continually improving relevant data reports to identify areas of actual and potential claims leakage based on Bupa Hospital and Medical contracts.

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.