Clinical Coding Intelligence Specialist
4 weeks ago
Job Summary
Bupa is seeking a highly skilled Clinical Coding Intelligence Analyst to join our team. As a key member of our Healthcare Insights team, you will play a pivotal role in improving our understanding of healthcare data through a clinical coding lens.
Key Responsibilities
- Analyse large datasets to identify trends, patterns, and anomalies related to healthcare costs, case-mix, utilisation, and outcomes.
- Support the development of risk adjustment tools for benchmarking purposes.
- Present complex data in a clear and actionable manner and translate data findings into actionable insights and strategic recommendations for stakeholders.
- Embed robust clinical coding intelligence into our clinical tools that support ongoing HCM Strategies.
- Develop a suite of clinical coding crosswalks, facilitating the translation of codes between different classification systems.
- Lead strategy development and implementation of ongoing management of Diagnosis Related Grouper (DRG) versions and the application to Bupa's funding models and claims system integration.
- Represent Bupa in industry-related engagements and working groups regarding clinical classification tools and DRG Grouper development.
Requirements
- Tertiary qualifications in Clinical Coding or Healthcare Information Management and/or Health Science field beneficial.
- Certified Professional Coder (CPC) or Coding Specialist (CCS)
- Minimum of 3-5 years of experience in clinical coding (preferably in a hospital environment), data analysis, with a strong understanding of coding systems in Australia i.e. ICD-10, ACHI and ACS, and coding in other global healthcare markets.
- Significant knowledge of healthcare data, clinical coding, case-mix principles, risk adjustment and the ability to build financial and benchmarking models.
- Proficiency in data analysis tools and software (e.g., SQL, SAS, Tableau, Excel, R and Python)
- Understanding of the Australian healthcare system and its ongoing reform.
- Proven capacity to communicate complex data insights clearly to technical and non-technical audiences.
What's in it for you?
As a Clinical Coding Intelligence Analyst at Bupa, you will have the opportunity to work with a talented team of professionals who are passionate about delivering exceptional experiences. You will be challenged and encouraged to innovate, and you will have access to a range of benefits and flexible working arrangements.
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