Private Health Insurance Audit Coordinator

3 weeks ago


South Brisbane, Australia Mater Misericordiae Ltd Full time

About the role

Mater Group is seeking a dedicated and detail-oriented Clinical Audit Specialist to join our Private Revenue team on a permanent full-time basis.

The Clinical Audit Specialist will be responsible for reviewing and coordinating Private Health Fund billing audits, identifying areas for quality improvement, and providing education and process re-engineering to Mater.

Key responsibilities

  • Review all health fund billing audits received by Mater Private Hospitals
  • Work closely with the PHI Audit Manager to determine the appropriateness of audit recommendations and resolve issues with health funds
  • Liaise and coordinate with internal teams to obtain additional information required for audits
  • Make recommendations for improvements based on audit results
  • Maintain the audit database and ensure responses to health funds are in accordance with instructions
  • Process audits within Key Performance Targets
  • Prepare internal requests for audit completion and liaise with Accounts payable and the Billing Team
  • Stay up-to-date with healthcare industry and legislation changes
  • Perform other tasks as reasonably required by the Manager PHI Audit

About you

To be successful, you need:

  • An understanding of clinical terms to assist in claim reviews
  • Strong organizational skills and ability to work on multiple tasks
  • A strong attention to detail
  • Strong skill level in Excel spreadsheets
  • Experience in private healthcare billing or PHI contract management
  • Experience in managing and reviewing Health Fund billing queries
  • Experience in interpreting Health Fund contractual obligations and associated billing rules

Why join us?

Mater Group is a leader in healthcare, education, and research, providing care for almost 700,000 patients a year across a network of 11 hospitals.

We offer a range of benefits, including salary packaging, access to education and professional development, and a commitment to staff wellbeing.



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