Clinical Coding Specialist
1 month ago
Job Summary
Bupa is looking for an experienced Clinical Coding Auditor to join our team. As a Clinical Coding Auditor, you will play a key role in ensuring hospital claims are accurate and compliant with regulatory requirements.
About the Role
We are seeking a seasoned Clinical Coding Auditor with extensive experience in healthcare clinical coding auditing, preferably within a hospital or health insurance setting. The ideal candidate will have a strong understanding of clinical coding standards, ICD, ACHI, and hospital contracts.
Key Responsibilities
- Conduct regular onsite and desktop provider audits to ensure accuracy and compliance.
- Review hospital claims to identify incorrect or inappropriate coding and billing practices.
- Validate provider-initiated DRG review requests based on coding and documentation analysis.
- Provide clinical/coding standards advice to inform statistical reports and identify potential claims leakage.
- Develop and improve relevant data reports to identify areas of actual and potential claims leakage.
Requirements
- Tertiary qualifications in health information management or clinical coding.
- Extensive experience in healthcare clinical coding auditing, preferably within a hospital or health insurance setting.
- Advanced clinical coding experience and a practical understanding of its impact on Diagnosis Related Groups.
- Familiarity with national, state, and territory coding guidelines in Australia.
- Understanding of private hospital contract management practices and concepts.
About Bupa
Bupa is an international healthcare group committed to helping people live longer, healthier, happier lives. We operate in Australia, New Zealand, and Hong Kong, supporting over 6.5 million customers through a range of health and care services.
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