Overview
This role is remote in Australia.
Working as a part of our Payment Integrity Practice, the Payment Integrity Specialist provides claims audit and recovery services to our private health insurer clients and provide expert feedback to improve our compliance solutions.
Responsibilities
Audit healthcare claims on behalf of our private health insurance clients to detect and recover overpayment.
Review clinical documentations submitted by providers
Provide insights into hospital billing practices that will improve the Company's ability to detect and recover overpayments
Support the growth of the Payment Integrity Practice by supporting business development activities
Strictly respect the confidentiality of all sensitive company and client information
Qualifications
One of the following qualifications:
Bachelor's Degree (Nursing or equivalent) with experience in Critical care, emergency department or operating theatre experience preferred
Health Information Manager
Clinical coder with a coding qualification with 5-8 years' experience
Experience:
Experience in auditing private hospital claims
Clinical coding experience highly desired
Understanding of private health insurance legislation and private hospital funding models
Experience working in the private health insurance sector or in private hospital audit
Familiarity with 3M codefinder
Excellent written and verbal communication skills
Effective time management, planning and organizational skills
Maintain knowledge and expertise by attending appropriate educational sessions
Ability to work remotely from home office
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