Clinical Compliance Specialist

1 week ago

Melbourne, Victoria, Australia beBeeCoder Full time $100,000 - $120,000

**Job Opportunity:**

We're seeking a skilled professional to reduce non-compliant hospital benefit outlay through strategic claims leakage prevention. This role involves undertaking hospital benefit contract compliance activities, including onsite and desktop provider audits.

The ideal candidate will possess tertiary qualifications in health information management or clinical coding, along with extensive work experience in healthcare auditing, preferably within a hospital or health insurance setting. Advanced clinical coding experience and a practical understanding of Diagnosis Related Groups (DRGs) are essential.

Key responsibilities include arranging and conducting regular onsite and desktop provider audits, validating provider initiated DRG review requests, and reviewing specific detail of hospital and medical claims for incorrect or inappropriate coding/billing practices.

Additional requirements include providing clinical/coding standards advice on statistical reports and initiating data report writing and interpretation.

This is a permanent role that offers hybrid work arrangements and the flexibility to work from home or in our office.

Regular interstate travel may be required. The successful candidate will possess excellent communication and problem-solving skills, as well as a strong attention to detail.

Our company values equality and diversity in recruitment, development, retention, and promotion of staff. We strive to create an inclusive workplace where everyone can thrive.

**Why Work With Us?**

A career at our organization offers more than just a job – it's an opportunity to make a real difference in people's lives. Our purpose is to help people live longer, healthier, happier lives, and we achieve this by delivering high-quality services and products that meet our customers' needs.

As a valued member of our team, you'll have access to ongoing training and development opportunities, enabling you to grow professionally and personally. Our goal is to foster a culture of collaboration, respect, and open communication, ensuring that everyone feels supported and empowered to succeed.

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