Medicare Claims Officer

Medicare Claims Officer

1 Full-time Permanent

Based in Cairns and Edmonton

Salary: Wuchopperen Health Service Limited Enterprise Agreement (2023)

Administrative grade 4 : $73, $80,714.79 per annum

Wuchopperen Health Service

'Keeping Our Generations Growing Strong'

Wuchopperen is a Community Controlled Aboriginal Health Organisation providing holistic health care services to the Aboriginal and Torres Strait Islander people of Cairns.

Benefits of working with Wuchopperen:

• We provide a positive work culture and a diverse and inclusive environment. Our people matter to us, and we are committed to supporting them:
• Competitive Salary + 12% Super + Salary Sacrifice (up to $15,899 for tax free benefits and $2,650 p/a for entertainment benefits).
• 5 weeks annual leave and 15 days personal leave pro rata.
• Commitment to professional development.
• EAP for employees and family members

About the role:

The Medicare Claims Officer provides technical, administrative, and associated guidance to the Director of Medical Services and Clinical Staff in the areas of Medicare billing, reporting and Practice Incentive Programs and other related programs as required across the organisation.

The Medicare Claims Officer reports to the Director Medical Services and does not have any supervisory responsibilities.

Significant liaison and coordination is required with Primary Health Care teams to ensure legislative requirements in relation to Medicare Benefits and associated programs are met.

This position works closely with members of the Clinical Governance and Primary Health Care teams and maintains regular contact with other program staff to ensure effective outcomes for clients.

Key responsibilities:

• Ensure compliance with all aspects of Medicare billings and Medicare requirements relating to claims including checking monies receipted, removing non-claimable items, resolving rejections, and performing resubmissions.
• Ensure compliance with the requirements of the Practice Incentives Program (PIP), Service Incentives Program and Practice Nurse Incentive Program (PNIP) and other programs as they become available, including liaison with Clinic Managers and clinical staff to ensure PIP form completion and the completion of PNIP quarterly workforce data.
• Provide education to new and existing staff in regards to Medicare billings and requirements, and PIP requirements, including existing, changed and new Item Numbers within the Medicare Schedule, and provide technical advice to clinical staff on Medicare billings, claimable items and other related restrictions and conditions.
• Report to the DMS and others on a range of indicators, including:

a. for Board reports on various Medicare Benefits Scheme (MBS) Items claimed;

b. to Finance for PIP and PNIP payments, as well as the EFTPOS Medicare income report;

c. to the DMS on monthly health checks completed and due by clinic;

d. to CheckUP Australia for the Location Visit Report for outreach services submitted online; and

e. to Medical Officers to fulfil doctors' contract requirements, as necessary.

• Manage Dental referrals both through Intramail and paper referrals to ensure eligibility for clients accessing Wuchopperen dental services, including liaison with the Dental Team and Medical Officers.
• Liaise with internal and external stakeholders as required regarding Medicare, PIP requirements and CheckUP Reporting.
• Provide, or provide support and education for administration staff to provide SMS reminders for appointments, health assessments, missed appointments, dental eligibility review and feedback to clinical staff.
• Maintain spreadsheets to provide information for monthly Medicare rejections for Integrated Team Care (ITC) / Care Coordination Supplementary Services (CCSS) and Commonwealth Home Support Program (CHSP) funds to the Clinic Managers to allow the Supplementary Services program to be billed for eligible Allied Health consultations.
• Ensure that non-Medicare billing including but not limited to Department of Veteran Affairs (DVA) and WorkCover is in accordance with guidelines, receipting of same and resolutions of outstanding payment
• Maintain a register of students and ensure that Teaching Incentives are maximized and claimed and ensure liaison with Supervisors and with feeder Universities for all billings to be captured. Also coordinate medical student timesheets for all Clinics and lodge student training PIP claims online.
• Gather and record statistical data relevant to measuring performance against agreed indicators and participate in review and evaluation activities.
• Participate in organisational and community activities to advance the health and wellbeing of Aboriginal and Torres Strait Islander people.
• Work within Wuchopperen's Policies and Procedures including the Staff Code of Conduct and the Work Health and Safety requirements and contribute to continuous improvement processes to ensure compliance with relevant standards and safe, effective service delivery.
• Other duties as required, within your skills, experience and capacity

Core Capabilities:

Assessment of merit for this role will be based on the knowledge, skills and experience, potential for development and personal qualities. The competencies listed below are considered to the most critical for success in this role.

For applicants to be successful in this role, they should demonstrate:

1. Demonstrated experience in practice management, Medicare billings, reports and a high level of competence and familiarity with the Practice Incentive Programs

2. Knowledge and understanding of Aboriginal and Torres Strait Islander societies and cultures from an historical and contemporary perspective, including the ability to communicate effectively and sensitively with Aboriginal and Torres Strait Islander people.

3. Demonstrated practical skills and experience in computing including Microsoft Office, and experience with computer database packages including patient information management systems and medical terminology.

4. Extensively developed interpersonal and communication skills including the ability to liaise with a range of stakeholders as well as effectively advocate for Aboriginal and Torres Strait Islander people.

5. Demonstrated ability to work independently and in a multi-disciplinary team environment, prioritise and meet deadlines, deal with matters of a sensitive and confidential nature.

6. Demonstrated ability to meet and work within the core values and behaviours of Wuchopperen.

Qualifications and experience:

• Demonstrated experience in practice management, Medicare billings, reports and a high level of competence and familiarity with the Practice Incentive Program. Practical skills and experience in computing including Microsoft Office, and experience with computer database packages including patient information management systems and medical terminology

Requirements:

• It is a condition of employment in this role for the employee to be, and remain, vaccinated against measles, mumps, rubella, varicella (chicken pox), pertussis (whooping cough) and hepatitis B

• It is recommended for the employee to be vaccinated against COVID-19.

• Proof of qualifications and current registration is required to be provided prior to the commencement of duty.
• Possession of a current CPR certificate or commitment to obtain within the first six weeks of employment is essential.
• Possession of a current Queensland "CA" class driver's licence is essential.
• .Commitment to work within the principles of Aboriginal and Torres Strait Islander community control including a willingness to develop the leadership of Aboriginal and Torres Strait Islander staff.
• All employees are responsible for the safety of themselves, students, visitors, volunteers and fellow staff members. Employees must report any hazards or incidents, co-operate in emergency drills, undertake Workplace H&S training as required, and lodge risk assessments for all external and internal risk activities.
• Ability to use Microsoft products and the ability to use or willingness to gain proficiency in the client information management systems.
• Hold a current Blue Card (for suitability to work with children and young people).
• Proof of qualifications is required to be provided prior to the commencement of duty.
• Possess a current driver's licence.
• A commitment to adhere to Wuchopperen's policies and procedures.

Applicants who do not address these requirements, will not be considered for shortlisting.

Note: Revised legislation requires applicants to hold a blue card prior to commencement. Refer to Qld Government's Blue Card Services website for more information.

How to apply:

To be eligible for interview, applicants must submit a cover letter (no more than two pages), addressing the Core Capabilities and an up-to-date Resume including two referees and complete the screening questions provided from Employment Hero.

For more information contact Nicci, Director, Medical Services on

Aboriginal and Torres Strait Islander People are encouraged to apply.

Wuchopperen is a Child Safe Organisation and the safety and wellbeing of children is of utmost importance.

Closing date for applications: 5pm on Monday 1st December 2025