Auditing and Compliance Expert
2 days ago
About the Role:
We're looking for an experienced Clinical Coder to join our team, focusing on ensuring claims are processed accurately and paid correctly. You'll work closely with our Clinical Audits team to achieve this goal.
Responsibilities:
- Conducting thorough onsite and desktop coding reviews.
- Partnering with the Clinical Audits team to ensure accurate claim processing.
- Applying advanced clinical coding experience and knowledge of ICD, ACHI, Clinical Coding Standards, and hospital contracts.
- Familiarity with national, state and territory coding guidelines in Australia.
- Recognizing clinical coding impacts upon Diagnosis Related Groups (DRGs).
Requirements:
- Tertiary qualifications in health information management or clinical coding.
- Extensive experience gained in healthcare auditing, preferably within a hospital or health insurance setting, conducting compliance investigations, hospital or claims audits (essential).
- Advanced clinical coding experience, and a practical understanding of their impacts on Diagnosis Related Groups (essential).
- Familiar with national, state and territory coding guidelines in Australia.
- Recognition of clinical coding impacts upon Diagnosis Related Groups (DRGs).
- Experience of auditing and claims in a health insurance environment.
- Knowledge of private hospital contract management practices and concepts.
- Proven experience in data report writing and interpretation.
- Computer literate, with moderate to advanced proficiency with Microsoft Excel, Word, PowerPoint and PowerBI.
- Understanding of Hospital Purchaser Provider Agreement contracts and relationship to claims.
What We Look For:
We're looking for a skilled Clinical Coder who can bring their expertise to our team. If you have the required skills and qualifications, we encourage you to apply.
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