THE OPPORTUNITY:

We’re looking for a Clinical Audits Support Analyst to help the Clinical Audits Team reduce non-compliant hospital benefit outlay through strategic claims leakage prevention. In this role, you’ll be undertaking hospital contract compliance activities (including the conduct and management of onsite and desktop provider audits); and validating provider billing practices.

• Clinical Coding qualifications.
• Experience in healthcare auditing, preferably within a hospital or health insurance setting OR a minimum of three years’ experience in hospital claims assessing and reviews.
• An understanding of clinical coding impacts upon Diagnostic Related Groups (DRGs).
• An understanding of national, state and territory coding guidelines within Australia.
• An understanding of Hospital Purchaser Provider Agreement contracts and relationship to claims.
• Proven experience in data report writing and interpretation.