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Claims Assessment Officer

3 weeks ago

Greater Adelaide SA, Australia St Andrew’s Hospital Full time

**Discover the St Andrew's Difference**
**Why St Andrew's?**
Discover a fulfilling career at St Andrew's leading standalone private hospital renowned for exceptional patient care. As a close-knit community, we value connections, accessible leadership, and active volunteerism. Our core values - caring for others, working together, and delivering excellence - define the St Andrew's way.

**Exciting Opportunities Await**

As a Hospital Funding and Claims Assessment Officer, you will be at the forefront of evaluation, assessing, and managing at risk admissions, ensuring precision, compliance, and efficient claims assessment. Your expertise, attention to detail, and in-depth knowledge of insurance policies and regulations will be instrumental in effectively managing and resolving claims issues.

Key Responsibilities:

- Review patient admissions, and billing information to determine claim eligibility.
- Verify insurance coverage and benefits for patients, including policy details, deductibles, and co-payments.
- Obtain admission and billing information from key stakeholders to determine patient Health Insurance financial status.
- Communicate proactively with stakeholders to resolve eligibility issues.
- Efficiently manage approvals for admissions and ex-gratia payments
- Provide accurate estimates to healthcare providers and patients upon request
- Prepare Costs letters and Informed Financial Consent to patients
- Maintains knowledge of Private health requirements, associated Private health Insurance Acts and MBS Schedule.
- Manage approval requests for various claims, including Compensable claims, Third Party claims, Victims of Crime, Department of Veteran's Affairs and Department of Defence.
- Provide assistance to the Patient Billing team during peak workloads; processing claims accurately and efficiently in accordance with established procedures and guidelines.

**Join Us If You Have**:

- Excellent communication and interpersonal skills
- Ability to work independently and collaboratively as part of a team in a fast-paced environment
- Effective time management skills with the ability to prioritise tasks to meet deadlines

**Why St Andrew's is the Place to Be**:
We prioritise the wellbeing of our staff and provide wellbeing programs, including an on-site gym, personalised support for mental health challenges and regular wellbeing tips. We have a strong focus on the health and safety of our workforce through dedicated WHS specialists, programs, and local health and safety representatives.

**Ready to Join Us?**

If you are ready to be part of something extraordinary, where your passion for patient care is celebrated, click the 'Apply' button, submit your CV & Cover Letter and take the next step in your career with St Andrew's.