Recoveries Specialist

4 weeks ago

Sydney, Australia Cotiviti Full time

Overview:

- Formally Lorica Health, now part of Cotiviti.

**Overview**
- Exciting opportunity to join a healthcare sector SaaS company
- Contract start date February 2023
- This is a full-time hybrid role based in Cotiviti's office in Sydney, Australia.

**About The Business**

Cotiviti is the leading provider of payment integrity services in the healthcare marketplace, nimbly delivering innovative analytics and technology that delivers products to drive revenue and value to customers.

Our passionate team of data scientists, software engineers, and domain experts build global SaaS products and tailored strategic services; that help to target fraud, abuse, waste, and errors within healthcare data.

**Responsibilities**:
**About The Role**

Join a software company that is helping to power better healthcare and make a difference in the lives of Australians and beyond. We are seeking an experienced Health Information Manager or Senior / Advanced Clinical Coder (5+ years experience with a broad range of surgical case mix) to work alongside a talented team of data scientists, analysts and engineers.

As an experienced Health Information Manager or Clinical Coder (5+ years experience) you will use your skills in Cotiviti’s Payment Integrity Practice which 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 and within Cotiviti. It is key to Cotiviti’s customer success, and you will be reporting to the Payment Integrity Practice Team Lead.

**Responsibilities**:

- ** Contribute**:

- The Recoveries Service for Lorica to drive customer value and revenue
- The ongoing maintenance of key stakeholder relationships internally and externally
- The ongoing growth and evolution of the Recoveries Service in line with Cotiviti’s strategy
- ** Recoveries**:

- Deliver value to 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
- ** Training, support and promotional activities**:

- Deliver training to employees of clients (as required)
- Support and assist with facilitation of HIBIS user forums (and other training or promotional events as required)
- Provide timely, professional and supportive responses to client enquiries
- Represent Cotiviti 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
- HIMAA Certificate in Clinical Coding
- Holds _full membership_ with the Health Information Management Association Australia

**Desired skills/experience**:

- Hospital billing experience
- Coding and case-mix experience (preferably including a private hospital context)
- Demonstrated understanding of private hospital funding models

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