Hospital Provider Auditor

1 week ago

Melbourne, Victoria, Australia Bupa Full time

At Bupa, our purpose is helping people live longer, healthier, happier lives and making a better world. We're a global people business that has been caring about health and happiness since 1947. Together, we're building our future on our shared values of being brave, caring, and responsible - our employee health and wellbeing program really is our purpose in action

**The Opportunity**

We have an opening for a highly motivated
**Hospital Provider Auditor** to join our Healthcare Management team. You'll be joining a team of diligent professionals to audit all health-related documentation, claims, and other documentation whilst ensuring compliance to regulations, internal policies and procedures. With a continuous improvement mindset, you'll recommend, develop and implement claims leakage strategies.
- This is a permanent full-time position based at our Brisbane, Melbourne or Sydney offices. (Bupa offers hybrid working and you can work from the office or at home)_

**Key responsibilities include**
- Initiate, manage and finalise hospital, clinical provider and member profiling reviews within an agreed annual work program
- Arrange and conduct onsite and desktop provider audits, managing the end-to-end processes including follow up and financial management of incorrect billing
- Initiate, write, develop and continually improve relevant data reports to identify areas of actual and potential claims leakage
- To identify any areas of actual or potential claims leakage, complete analysis of relevant hospital and medical contracts
- Review individual hospital and medical claims to identify incorrect servicing, coding or billing practices and instigate recoveries
- Provide clinical/coding advice on statistical reports to determine appropriate action or further investigation required.

**Benefits**

We keep our people smiling by helping them improve their lives in and outside of the office. We're a welcoming lot, no matter who you are or where you've come from. We welcome all talents and backgrounds and embrace our differences, so you can bring your true self to work. We support our people to be the best version of themselves, physically and mentally. With a healthy work/life balance, leadership support, reduced private health cover, study leave, volunteering options and a commitment to promoting from within.

Our employees can access wide range of benefits: from our own products (incl. subsidised health insurance) to many other products and services via our partnerships program (like Apple, Samsung, JB Hi-Fi, plus gym and spa discounts to name a few). We reward our people and celebrate their success, provide initiatives that develop careers and look after our people's health, wellbeing, and futures.

**As Hospital Provider Auditor, you'll require -**
- Practical work experience in conducting, overseeing and training others in benefit compliance and claims integrity activities within a healthcare setting (preferably within a hospital and/or health insurance environment).
- Involvement in planning and conducting audit activities and programs.
- Advanced clinical coding experience and a practical understanding of their impacts on Diagnosis Related Groups
- A solid understanding of
- hospital casemix concepts,
- hospital contract management practices and concepts including Hospital Purchase Provider Agreement contracts and their relationships to claims
- Ancillary and Medical fund rules, provider agreements and relationship to claims.
- Proficient skills in data report writing and interpretation
- Tertiary qualifications in clinical coding or health information management

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