Payment Integrity Specialist

This is a fully remote position, open to applicants in Australia.

📋 Description

• Conduct audits on healthcare claims for our private health insurance clients to identify and recover overpayments.

• Evaluate clinical documentation provided by healthcare providers.

• Offer insights into hospital billing practices to enhance the Company's capacity to identify and reclaim overpayments.

• Contribute to the expansion of the Payment Integrity Practice by assisting in business development initiatives.

• Adhere strictly to the confidentiality of all sensitive information pertaining to the company and its clients.

⛳️ Requirements

• Possession of one of the following qualifications: Bachelor’s Degree (Nursing or equivalent) with preferred experience in critical care, emergency department, or operating theatre.

• Certification as a Health Information Manager.

• Clinical coder with a coding qualification and 5-8 years of relevant experience.

• Proven experience in auditing claims from private hospitals.

• Clinical coding experience is highly desirable.

• Knowledge of private health insurance legislation and funding models for private hospitals.

• Background in the private health insurance industry or experience in private hospital audits.

• Proficiency with 3M codefinder.

• Strong written and verbal communication abilities.

• Effective time management, planning, and organizational skills.

• Commitment to maintaining knowledge and expertise through participation in relevant educational sessions.

• Capability to work remotely from a home office.

🏝️ Benefits

• Health Information Manager

• Clinical coder with a coding qualification with 5-8 years' experience.