Payment Integrity Officer

1 week ago

Sydney, New South Wales, Australia Teachers Health Full time

Attractive leave benefits Hybrid working model Subsidised private health insurance Payment Integrity Officer – 12-Month Fixed-Term ContractYou'll be responsible for ensuring that claims submitted by Hospital providers on behalf of members comply with internal fund rules and AHSA contract guidelines.
Using HIBIS and other reporting tools, the role will liaise with contacts at Hospitals to validate flagged claim anomalies, and work with internal claims assessors to educate on processing issues leading to benefit leakage.
What we have to offer?
We at Teachers Health have a lot to offer, Attractive leave benefits Hybrid working model (flex your work/life balance) Subsidised private health insurance Discounts on our products and services Generous employee wellbeing program Easily accessible by public transport Who are we?
Teachers Health was created by teachers for teachers over 70 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 400,000 teachers, education staff & their families.
What will you do?
Daily review of alerts in claim auditing tool HIBIS.
Work within settlement terms to prevent release of payment for claims flagged with billing anomalies.
Complete 'stop payment' processes within the system where appropriate.
Regular review of HIBIS alerts 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 flagged through various audit activities.
Completion of regular control processes around payment duplication and quality assurance.
Provide feedback and recommendations to stakeholders when issues are identified.
Complete refund request and payment allocation processes in the system for any recoverable amounts identified across various audit types.
Provide ongoing education to claims assessors on processing issues that are identified during various audit activities.
Review, develop and update relevant policies and procedures and assist with identifying areas where processes may be streamlined and improved.
What do you need?
Experience in claims/benefits assessment within private health insurance, or healthcare billing/revenue assurance roles Strong Microsoft Excel skills High attention to detail and strong organisational/time management skills Excellent written and verbal communication skills Stakeholder management experience General understanding of the Australian healthcare landscape Knowledge of medical terminology Experience with HAMBS or similar systems (desirable) How do I apply?
Click APPLY NOW to submit your updated CV, along with an optional cover letter or a 60-second introduction video sharing why you'd be a great fit for the role.
Teachers Health values diversity and inclusion and encourages applications from people with diverse backgrounds including First Nations people, people with disability, people from diverse cultural and linguistic backgrounds, and people that identify as LGBTQIA+.
Applicants can request an adjustment at any stage during the recruitment process by getting in touch with **************************

  • Payment Integrity Specialist

    6 days ago

    Sydney, New South Wales, Australia Cotiviti Full time

    Overview:Working as a part of our Payment Integrity Practice, the Payment Integrity Specialist provides claims audit and recovery services to our private health insurer clients and provide expert feedback to improve our compliance solutions.**Responsibilities**:- Assess healthcare claims on behalf of our private health insurance clients to detect and recover...

  • Payment Integration Specialist

    2 weeks ago

    Sydney, New South Wales, Australia beBeeIntegration Full time $100,000 - $105,000

    Job Title:">Integration ExpertThis is an excellent opportunity for a technically skilled professional in the payments industry, looking to gain experience in customer-facing functions and take on responsibilities related to software integration.Supporting external partners with utilizing our APIs and other integration solutions.Undertaking partner briefings,...

  • Payment Integrity Specialist

    1 week ago

    Sydney, New South Wales, Australia Cotiviti Full time

    Overview:The Payment Integrity Specialist provides outsourced claims audit and recovery services to private health insurer clients using HIBIS leakage detection software and provide expert feedback to improve Cotiviti Australia solutions.**Responsibilities**:- Deliver value to clients by using HIBIS to detect and recover claims leakage- Provide insights into...

  • Technical Payment Integration Specialist

    1 week ago

    Sydney, New South Wales, Australia beBeePayment Full time $100,000 - $134,000

    Integration ExpertThis is a great opportunity for a payments enthusiast to take on the role of Integration and Technical Product Specialist at a leading company in Sydney.About the RoleWe are seeking a highly skilled individual to serve as the primary point of contact for external partners and be the expert on API integrations for new partners.The successful...

  • Payments Officer

    1 week ago

    Sydney, New South Wales, Australia Hays Full time

    Government Payments role I Based in Parramatta I 12 Mth Contract to start in April**Your new company**A large Government organisation that provides a range of community services requires an experienced Payments Officer for a 12 Month contract. Parramatta basedPLEASE NOTE THIS ROLE REQUIRES AUSTRALIAN CITIZENSHIP**Your new role**This Payments Officer role has...

  • Payment Services Officer

    1 week ago

    Sydney, New South Wales, Australia Australian Military Bank Full time

    **Work options**: Hybrid3 Days in officeWe are a member owned financial institution who has a national presence serving the banking needs of the Australian Defence Force and wider community. We pride ourselves on a culture of collaboration, flexibility and diversity. We offer mortgages, consumer and credit loan facilities as well as products and services...

  • Payment Services Officer

    1 week ago

    Sydney, New South Wales, Australia Australian Military Bank Full time

    We are a member owned financial institution who has a national presence serving the banking needs of the Australian Defence Force and wider community. We pride ourselves on a culture of collaboration, flexibility and diversity. We offer mortgages, consumer and credit loan facilities as well as products and services within superannuation, everyday...

  • Payment Services Officer

    1 week ago

    Sydney, New South Wales, Australia Australian Military Bank Full time

    We are a member owned financial institution who has a national presence serving the banking needs of the Australian Defence Force and wider community. We pride ourselves on a culture of collaboration, flexibility and diversity. We offer mortgages, consumer and credit loan facilities as well as products and services within superannuation, everyday...

  • Chief Payment Integrity Specialist

    1 week ago

    Sydney, New South Wales, Australia beBeeFraud Full time $120,000 - $180,000

    Senior Business Analyst Opportunity We are seeking an experienced Senior Business Analyst to support projects improving payment integrity and reducing fraud across national programs. The ideal candidate will be responsible for analysing data, interpreting results, and producing reports using advanced statistical techniques. They will lead the development...

  • Payment Officer

    1 week ago

    Sydney, New South Wales, Australia Ampersand Full time

    $40 - $45 p/h + Super- 6 Month Contract- Parramatta / WFH**Payments Officer | 6 Months | $45 p/h + Super**- $40 - $45 p/h + Super- 6 Month Contract- Parramatta / WFH**About the Role **We are currently seeking to appoint a Payment Officer with a leading NSW Government agency responsible for providing excellent support to operational businesses in delivering...