Clinical Coding Intelligence Specialist
4 weeks ago
The Clinical Coding Intelligence Analyst will play a pivotal role in improving our understanding of healthcare data through a clinical coding lens. This role is responsible for identifying clinical trends and insights from our claims and alternative data sources, supporting the development of risk adjustment tools for benchmarking purposes.
Key Responsibilities
• Analyze large datasets using clinical coding intelligence to identify trends, patterns, and anomalies related to healthcare costs, case-mix, utilization, and outcomes.
• Support the Healthcare Insights Teams to present complex data in a clear and actionable manner, translating data findings into actionable insights and strategic recommendations for stakeholders.
• Embed robust clinical coding intelligence into our clinical tools that support ongoing HCM Strategies.
• Develop a suite of clinical coding crosswalks, facilitating the translation of codes between different classification systems, with the ability to adopt useful data assets from other markets, allowing data integration and migration, billing and reimbursement, clinical research and analysis, and participation in comparative studies.
• Lead strategy development and implementation of ongoing management of Diagnosis Related Grouper (DRG) versions and the application to Bupa's funding models and claims system integration.
• Represent Bupa in industry-related engagements and working groups regarding clinical classification tools and DRG Grouper development.
• Present findings and recommendations to senior management and other key stakeholders, working closely with IT and data management teams to ensure data integrity and system compatibility.
Requirements
• Tertiary qualifications in Clinical Coding or Healthcare Information Management and/or Health Science field beneficial.
• Certified Professional Coder (CPC) or Coding Specialist (CCS)
• Minimum of 3-5 years of experience in clinical coding (preferably in a hospital environment), data analysis, with a strong understanding of coding systems in Australia (i.e., ICD-10, ACHI, and ACS) and coding in other global healthcare markets.
• Significant knowledge of healthcare data, clinical coding, case-mix principles, risk adjustment, and the ability to build financial and benchmarking models.
• Proficiency in data analysis tools and software (e.g., SQL, SAS, Tableau, Excel, R, and Python)
• Understanding of the Australian healthcare system and its ongoing reform
• Experience with private healthcare sector and regulatory requirements
• Proven capacity to communicate complex data insights clearly to technical and non-technical audiences, including gathering requirements and presenting results.
• Proven capacity to work well independently and to collaborate with others, as required.
• Excellent analytical, problem-solving, and critical-thinking skills.
• Strong attention to detail and commitment to data accuracy.
• Exceptional written and presentation skills and the ability to convert data into insight and prepare compelling, persuasive reports and presentations suitable for executive and board-level content.
• Excellent time management skills
• A track record of achievement and delivery
What's in it for you?
As well as a competitive salary, a range of Bupa benefits, and flexible working/work from home, 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.
• Discount on our health insurance, travel, car, home, contents, and pet insurance products, as well as Bupa services such as Dental and Optical
• A 'People First' wellness program – SMILE. Provides a range of services such as health coaches, annual skin checks, and flu vaccinations, assistance with nutrition, mental and general well-being guides, and product discounts. You will feel happier & healthier for working at Bupa
At Bupa, we are striving to create and sustain a safe and inclusive workplace. We welcome applicants from all cultural backgrounds, genders, and abilities. If you require any adjustments to participate in our recruitment process, please let us know at the time of your application.
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