Operational Efficiency Specialist

2 weeks ago

Brisbane, Queensland, Australia beBeeClinical Full time $90,123 - $123,456
Job Title

We are seeking a skilled professional to play a key role in ensuring hospital cost savings.

  • This includes developing and implementing claims leakage strategies, system rule improvements, and controls.
About the Role

The successful candidate will undertake hospital contract compliance activities, including onsite and desktop provider audits.

  1. Conducting audits to validate provider billing and coding practices.
Responsibilities

Key responsibilities of the role include:

  • Initiating and finalising hospital, clinical, provider, and member profiling reviews within an agreed annual work program.
  • Arranging and conducting regular onsite and desktop provider audits, including follow-up and financial management of incorrect billing.
  • Reviewing hospital claims to advise on incorrect or inappropriate coding/billing practices.
  • Validating provider-initiated DRG review requests based on coding and documentation analysis.
  • Providing clinical/coding standards advice on statistical reports produced by Data and Claims Analysts.
  • Developing and continually improving relevant data reports to identify areas of actual and potential claims leakage.
Requirements

To be considered for this role, you must have:

  • A registered nursing qualification with experience in operating theatres and implantable prosthesis management.
  • Relevant tertiary qualifications in nursing and/or health information management.
  • Proven experience in a major hospital with significant exposure to operating theatres and implantable prosthesis management.
Bupa Values

We value our employees and strive to create a positive and inclusive work environment.

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