Prosthesis Clinical Analyst
2 weeks ago
About the opportunity
Be at the heart of helping people live longer, healthier, happier lives.
You might think you know a lot about Bupa. You'll know we provide health insurance and aged care services across Australia, and you've probably also seen our dental and optical clinics in your local shopping centres. But what you might not realise is that we have an entire team of professionals working behind the scenes to ensure we are providing the best possible outcomes for our customers across all areas of the business.
This role is an opportunity to utilise your clinical skills in a corporate environment and offers an opportunity to grow your career with a global health care brand where our customers are at the heart of everything we do.
About the role
Our Prosthesis Clinical Analyst is an important role that bridges the gap between Bupa, the hospital system, and its customers. Utilising your clinical knowledge and expertise, you will ensure hospital cost savings as a result of developing and implementing claims leakage strategies, system rule improvements, and controls. You will also be undertaking hospital contract compliance activities (including the conduct and management of onsite and desktop provider audits) and validating provider billing and coding practices.
- Please note - This role can be based in Brisbane, Sydney, or Melbourne.
Key accountabilities include:
- Initiate, manage, and finalise hospital, clinical, provider, and member profiling reviews within an agreed annual work program.
- Arrange and conduct regular onsite and desktop provider audits, manage end-to-end processes including follow-up and financial management of incorrect billing.
- Review the specific detail of hospital claims to advise where there are incorrect or inappropriate coding/billing practices.
- Validate provider-initiated DRG review requests based on coding and documentation analysis.
- Provide clinical/coding standards advice on statistical reports produced by Data and Claims Analysts to determine if further investigation and action is warranted.
- Initiate, write, develop, and continually improve relevant data reports to identify areas of actual and potential claims leakage based on Bupa Hospital and Medical contracts.
About you
We're looking for someone with the following skills:
- Registered Nurse eligible for registration in Australia (Operating Theatres – Scrub/Scout) and/or Medical Device Company clinical support experience.
- Relevant tertiary qualifications in nursing and/or health information management.
- Proven experience in a major hospital with significant exposure to Operating Theatres and Implantable Prosthesis Management.
- Understanding of clinical coding impacts upon Diagnosis Related Groups (DRGs).
- Understanding of hospital casemix concepts in the Private Health Insurance setting.
- Understanding/experience of auditing and claims in a health insurance environment.
- Private Health Insurance work experience.
- Understanding of private hospital contract management practices and concepts.
- Understanding of Hospital Purchaser Provider Agreement contracts and their relationship to claims.
- Understanding of Ancillary and Medical fund rules, provider agreements, and their relationship to claims.
- Proven experience in data report writing and interpretation.
- Computer literate, with moderate to advanced proficiency with Microsoft Excel, Word, PowerPoint, and PowerBI.
Be at the heart of it with Bupa
This is your opportunity to make a real impact on our services to help shape the health outcomes for Bupa and its customers.
Apply now, we'll start interviewing as soon as we receive your application – For more information or to talk with our Talent Acquisition Partner please email Aiden Wallage (aiden.wallage@bupa.com.au)
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, is what inspires us. It's a promise to our customers to change lives 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 drive, 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.
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