Payment Integrity Officer

3 days ago

Sydney, Australia Teachers Health Full time

6 weeks of annual leave
- Hybrid working model
- Fantastic central location in Surry Hills

**Payment Integrity Officer**
The Payment Integrity Officer is responsible for ensuring claims submitted by Hospitals are compliant with fund rules and guidelines.

**What do we have to offer?**
- 6 weeks of annual leave
- Hybrid working model
- Subsidised private health insurance and discounts on our products and services
- Fantastic central location in Surry Hills
- Employee well-being program
- An annual corporate wardrobe allowance
- 18 weeks paid parental leave for eligible employees
- Additional long service leave

**Who are we?**
Teachers Health was created by teachers for teachers over 65 years ago and is the only health fund exclusively for the education community. As a not-for-profit health fund, we exist for our members covering the lives of over 370,000 teachers, education staff & their families.

**How will you help?**
The Payment Integrity Officer plays a key role in the Benefits Assurance team, responsible for ensuring 'that claims submitted by Hospital providers comply with internal fund rules and Australian Health Service Alliance (AHSA) guidelines. Some of the key responsibilities are to:

- Review alerts in our Hospital claim auditing tool. Work within settlement terms to prevent release of payment for claims flagged with billing and coding anomalies.
- Regular review of billing and coding anomalies for claims that have fallen outside of payment settlement terms. Prepare audit batches and liaise with Hospital staff to review anomalies and recover leaked benefits.
- Liaise with the Clinical Coding Auditor to review clinical scenarios and coding issues
- Complete regular control processes around payment duplication and quality assurance.
- Provide feedback and recommendations to stakeholders when issues are identified.
- Provide ongoing education to claims assessors on processing issues that are identified during various audit activities.

**What do you need?**
- Relevant tertiary qualifications and/or significant experience within private health insurance or healthcare industry.
- Demonstrated experience in claims or benefits assessing roles within Private Health Insurance
- Amazing attention to detail skills
- Proficient with MS Office programs, especially Excel.
- High level communication skills

**How do I apply?**
Click APPLY NOW and send in your updated CV and an (optional) cover letter, telling us why you would be a good fit for the role.

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