Payment Integrity Specialist

Overview

This role is remote in Australia.  In order to be considered for this role, the candidate must reside in Australia. 

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

• Audit healthcare claims on behalf of our private health insurance clients to detect and recover overpayment.
• Review clinical documentations submitted by providers.
• Provide insights into hospital billing practices that will improve the Company’s ability to detect and recover overpayments.
• Support the growth of the Payment Integrity Practice by supporting business development activities.
• Strictly respect the confidentiality of all sensitive company and client information.

Qualifications

One of the following qualifications:

• Bachelor’s Degree (Nursing or equivalent) with experience in Critical care, emergency department or operating theatre experience preferred.
• Health Information Manager.
• Clinical coder with a coding qualification with 5-8 years' experience.

Experience:

• Experience in auditing private hospital claims.
• Clinical coding experience highly desired.
• Understanding of private health insurance legislation and private hospital funding models.
• Experience working in the private health insurance sector or in private hospital audit.
• Familiarity with 3M codefinder.
• Excellent written and verbal communication skills.
• Effective time management, planning and organizational skills.
• Maintain knowledge and expertise by attending appropriate educational sessions.
• Ability to work remotely from home office.

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