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Clinical Coding Auditor
1 month ago
We are seeking a seasoned Clinical Coding Auditor to join our team at Bupa. As a Clinical Coding Auditor, you will play a critical role in ensuring hospital claiming compliance by conducting onsite and desktop clinical coding reviews.
Key Responsibilities:- Conduct regular onsite and desktop provider audits to ensure compliance with coding and billing standards.
- Review hospital claims to identify incorrect or inappropriate DRG, ICD, or ACHI coding and billing practices.
- Validate provider-initiated DRG review requests based on coding and documentation analysis.
- Provide clinical and coding standards advice on statistical reports to determine if further investigation and action are warranted.
- Initiate and develop relevant data reports to identify areas of actual and potential claims leakage based on Bupa Hospital and Medical contracts.
- Ensure compliance with Bupa's risk and compliance policies, procedures, frameworks, and regulatory 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 impacts on Diagnosis Related Groups.
- Familiarity with national, state, and territory coding guidelines in Australia.
- Understanding of private hospital contract management practices and concepts.
- Understanding of Hospital Purchaser Provider Agreement contracts and their relationship to claims.
- Proven experience in data report writing and interpretation.
- Computer literacy with moderate to advanced proficiency in Microsoft Excel, Word, PowerPoint, and PowerBI.
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. We employ over 20,000 people in the region and believe that we can make a real difference to the lives of our customers through our values, purpose, and personalized care.
