Medical Consultant
1 day ago
Medical Consultant Role
The position of Medical Advisor plays a vital role within the international health sector. As a key member of the team, you will be responsible for reviewing and adjudicating all medical claims, treatment requests, and Guarantee of Payments including monitoring high-cost cases (claims above $50K), while operating within established policy and procedure guidelines.
As part of your responsibilities in the international health team, you will be accountable for liaising with medical providers to determine appropriate rates and charges for treatment and identifying opportunities for cost containment.
Key Responsibilities:- Treatment Guarantee and Guarantee of Payment Assessment:
- Assess suitability of treatment/procedures requests for providers and members to confirm Guarantee of Payment for medical services in accordance with policy wording, Medicare Benefit Schedule, Pharmaceutical Benefit Schedule, and Private Healthcare Prostheses guidelines.
- Maintain confidentiality between health professionals and members in accordance with Privacy Legislation.
- Provide support, direction, and education on related medical terms, treatments, and conditions to non-clinical personnel.
- Liaise with the Chief Medical Officer for medical advice.
- Medical Claims Adjudication and Cost Containment:
- Review and assess all medical claims/invoices in accordance with policy wording, Medicare Benefit Schedule, Pharmaceutical Benefit Schedule, and Private Healthcare Prostheses guidelines.
- Identify cost-saving opportunities as a key aspect of the claims adjudication process.
- Familiarity with overseas student and visitor healthcare policies, Medicare Benefit Schedule, Pharmaceutical Benefit Schedule, Private Healthcare Prostheses guidelines, public state rates, and Australian Health Service Alliance guidelines is essential.
- High-Cost Case Management:
- Review and assess all medical claims/invoices in accordance with policy wording, Medicare Benefit Schedule, Pharmaceutical Benefit Schedule, and Private Healthcare Prostheses guidelines.
- Assess suitability of treatment/procedures requests for providers and members to confirm Guarantee of Payment for medical services above $50K in accordance with policy wording, Medicare Benefit Schedule, Pharmaceutical Benefit Schedule, and Private Healthcare Prostheses guidelines.
- A tertiary qualification recognized by the relevant authority as a registered nurse and experience in the primary healthcare sector are required.
- Emergency nursing experience is highly regarded but not essential.
- A commitment to ongoing professional development is necessary.
- Nursing registration must remain current and restrictions-free.
- Excellent PC skills, including basic knowledge of Microsoft Word, Excel, and PowerPoint programs.
- Possess excellent verbal, non-verbal, and written communication skills when interacting with different levels of staff throughout the organization and individuals external to the department.
- Good problem-solving capabilities with an advanced diagnostic and methodical approach.
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