Private Health Insurance Audit Coordinator
3 weeks ago
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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