Team Lead, Payment Integrity Practice

7 days ago

Sydney, Australia Cotiviti Full time

Overview:
Cotiviti Australia is currently seeking a Health Information Manager for an exciting opportunity at a leading healthcare analytics company. We are looking for a Health Information Manager to lead our Payment Integrity Practice and work alongside a talented team of data scientists, analysts and engineers.

Join a company that is helping to power better healthcare and make a difference to the lives of Australians and beyond. At Cotiviti Australia we power better healthcare by enabling transparency in healthcare markets.

Cotiviti Australia is part of Cotiviti, a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value.

This is a fulltime position based in Sydney with hybrid working arrangement.

**Responsibilities**:
As Health Information Manager (5+ years’ experience) you will lead Cotiviti Australia’s Payment Integrity Practice that provides outsourced claims audit and recoveries services. You will be responsible for helping clients identify and recover overpayments as well as providing support, guidance and training. This role provides a variety of experiences across payment integrity in the healthcare industry. This role is key to our customer success and reports to the Head of Customer Experience and Partnerships.

**Lead**
- A team of Health Information Managers, Clinical coders and Registered nurses providing Recoveries Service on behalf of our customers
- The development of key stakeholder relationships internally and externally
- The growth and evolution of the Recoveries Service in line with our company strategy

**Recoveries**
- Deliver value to our clients by leveraging your knowledge and experience to assess alerts in our proprietary system, HIBIS, to identify potential overpayments
- Manage the qualification and recovery process on behalf of clients including:

- Reviewing surrounding data in the client’s operating system to qualify the alert and calculate potential overpayment
- Liaising with key contacts at hospital providers to review supporting documentation and handle objections
- Represent the client in assessing whether a repayment is due
- Follow up with hospitals until any overpayment is repaid

**Support and promotional activities**
- Support and assist with facilitation of Cotiviti customer forums (and other training or promotional events as required)
- Provide timely, professional and supportive responses to client enquiries
- Represent Cotiviti Australia at industry events and conferences
- Provide timely advice and support to internal and external stakeholders

**Product development**
- Provide insights into hospital or medical billing practices to the product teams
- Suggest new rules or enhancements to existing rules within HIBIS to drive further value for clients and reduce the incidence of false positives (incorrect alerts)
- Identify product enhancements and features to further develop user experience

**Stakeholder relations**
- Manage and maintain strong relationships with clients, hospitals, industry bodies and other key stakeholders
- Provide outstanding customer service to clients

**Business development**
- Support the Head of Customers and Partnerships with business development initiatives (as required)

**Confidentiality**
- Strictly respects the confidentiality of all sensitive company and client information

**Personal development**
- Maintain currency of knowledge and experience applicable to the role including, but not limited to, ICD-10-AM coding, DRGs and private hospital funding models
- Meet any requirements (including mandatory professional development) to retain accreditation/s applicable to the role

Qualifications:

- University degree in Health Information Management or equivalent
- Certificate in clinical coding auditing (highly desirable)
- Holds _full membership_ with the Health Information Management Association Australia

**Desired skills/experience**:

- Coding and casemix experience (preferably including a private hospital context)
- Demonstrated understanding of private hospital funding models
- Clinical coding audit experience
- Experience working in Private Health Insurance (highly desirable)
- Experience in handling Private Health Insurance contracts and billing procedures
- Team management experience

**Role specific characteristics**:

- Excellent written and verbal communication skills
- Dynamic approach to managing multiple customers and their associated accounts, access points and inboxes
- Inquisitive by nature
- Is a self-starter
- Ability to work both independently (remotely from home office) and as part of a team
- Proactive, accountable for resolving issues or client concerns and a demonstrated passion for continuous improvement
- High attention to detail, accuracy and highly proficient time management skills
- Ability to travel (both nationally and internationally) as required

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