Clinical Coding Auditor

3 months ago

Melbourne, Australia Bupa Full time

In this exciting new role as the Clinical Coding Auditor - you will ensure hospital claiming compliance as a result of conducting onsite and desktop clinical coding reviews. Working in conjunction with our Clinical Audits team, you will ensure hospital claims lodged are paid appropriately by auditing the coding of diagnosis and procedure codes in line with ICD, ACHI, Clinical Coding Standards, and hospital contracts. Dependent on location, regular interstate travel is required.

We are looking for a seasoned Clinical Coding Auditor with extensive experience gained in healthcare clinical coding auditing, preferably within a hospital or health insurance setting, conducting compliance investigations, hospital or claims audits.

**How will I help?**

Key accountabilities include:

- 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 DRG, ICD or ACHI 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,
- Legal and regulatory compliance, adherence to internal operating procedures, together with the management of business risks is the responsibility of every Bupa employee.

**What’s in it for me?**

As well as a competitive salary, a range of Bupa benefits and flexible working/ work from home arrangements, you’ll be challenged and encouraged to innovate. You will collaborate strongly with colleagues who are committed to delivering exceptional experiences. We trust, respect and consider everyone, knowing your difference will make the difference.

**What do I need?**
- Tertiary qualifications in health information management or clinical coding.
- Extensive experience gained in healthcare clinical coding auditing, preferably within a hospital or health insurance setting, conducting compliance investigations, hospital or claims audits (essential)
- Advanced clinical coding experience, and a practical understanding of their impacts on Diagnosis Related Groups (essential)
- Familiar with national, state and territory coding guidelines in Australia
- Understanding of private hospital contract management practices and concepts.
- Understanding of Hospital Purchaser Provider Agreement contracts and 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.

**What is it like to work there?**

Bupa is an international healthcare group which has been committed to a purpose of helping people live longer, healthier, happier lives and making a better world for more than 70 years.

Bupa Asia Pacific operates in Australia, New Zealand, and Hong Kong, supporting about 6.5 million customers through a broad range of health and care services including health insurance, aged care, dental, medical, optical, and hearing services.

Employing more than 20,000 people in the region, we believe that we can make a real difference to the lives of customers through our values, purpose, and the way that we deliver personalised care.

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