Health Fund Compliance Coordinator at Epworth

Melbourne, Victoria, Australia -

Full Time

Start Date

Immediate

Expiry Date

22 Feb, 26

Salary

15900.0

Posted On

24 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Health Administration, Health Information Management, Clinical Documentation, Analytical Skills, Problem-Solving, Relationship Building, Revenue Optimization, Contract Compliance

Industry

Hospitals and Health Care

Description

Company Description Epworth HealthCare is Victoria’s largest not-for-profit private health care group, renowned for excellence in diagnosis, treatment, care and rehabilitation. Epworth is an innovator in Australia’s health system, embracing the latest in evidence-based medicine to pioneer treatments and services for our patients. At Epworth, we are united in our commitment to fostering a diverse and inclusive workplace—one that is culturally safe and respectful of the enduring cultural and spiritual connections of our people. We value all differences, ensure equitable practices, and empower individuals to lead and learn inclusively in their everyday interactions. Our goal is to create an environment where everyone feels a genuine sense of belonging. Our values and purpose define Epworth's approach and delivery. We pride ourselves on communicating and delivering them in a real and meaningful way. Every Patient Matters. Job Description Supporting the Health Fund Contract Manager to ensure that hospital claims comply with health fund contracts and provide advice on health fund claim audits and other contract issues, your primary responsibilities will be to review/process health fund audits, analyse health fund claim audits against clinical documentation and health fund contract clauses, and liaise with Patient Revenue, clinical coders and other operational management as necessary to determine agreement (or not) with the health fund audit request. Your ability to deliver well-reasoned and evidence-based responses will enable clear communication of audit outcomes to health fund auditors and Epworth divisional management, while identifying opportunities to improve processes related to health fund audits and billing practices. Strong collaboration and relationship-building skills will support Patient Revenue in reviewing and assessing the collectability of unpaid health fund accounts, including providing clinical information to facilitate payment. Additionally, you will help identify opportunities for revenue optimization and ensure contract compliance. You will make an impact by: Supporting Patient Revenue in reviewing and assessing the collectability of unpaid health fund accounts, including the provision of clinical information to health funds to support the payment of those accounts. Liaising with operational divisions, as required, to obtain the necessary information to support the payment of outstanding accounts. Identifying audit trends and opportunities for process improvements to reduce the volume/impact of future audits. Identifying opportunities for revenue optimisation and contract compliance. Qualifications To be successful in this role: You will have: Diploma or university degree in the field of health administration, health information management, nursing or other health related discipline Experience in private/public hospitals and healthcare funding systems Post-graduate clinical experience Able to exercise independent judgement and act on it Ability to analyse medical data and interpret in the context of contractual arrangements • Excellent analytical and creative problem-solving skills Position Description Inherent Requirements Additional Information Why Join Epworth? At Epworth, it’s a community. It’s the sense of belonging and being part of an organisation and a team that works to make sure that every patient matters. In addition to this, you will have access to: Salary package up to $15,900 pre-tax annually, leading to greater take home pay The largest educational scholarship program of its kind in Australia Ability to purchase up to four additional weeks of leave Reduced cost of health services for you and your family at Epworth Relocation assistance is available for approved candidates At Epworth, we care. We care about our patients and we care about our people. We care about keeping everyone safe. We care about valuing and empowering our people, and growing careers. And we care about giving our people support and flexibility to thrive, and contribute to our communities. We welcome applicants from all backgrounds. This includes First Nations peoples, people with disability, mature-age and young job seekers, members of the LGBTIQA+ community, and individuals from all cultural backgrounds. We are committed to providing an equitable, inclusive, and barrier-free recruitment experience for everyone. If you need support during the application process or would like to discuss reasonable adjustments, we encourage you to let us know what you need to participate fully and confidently. We understand that sharing your needs can feel daunting, so please know that any information you provide will be treated with the utmost confidentiality and respect. Enquire/ Apply Sound interesting? To apply, click the I'm Interested button to attach your CV and cover letter. For more information, refer to the attached position description or contact [email protected] or phone (03) 9426 0606. It is a condition of employment with Epworth HealthCare, subject to reasonable exemptions, that you have had an annual Influenza vaccination, where this is required under Epworth policy. As a child safe organisation, all successful applicants are required to satisfactorily clear a National Police Check (conducted by Epworth) and may be required to hold a valid employee Working with Children Check (provided by you). At Epworth, we believe inclusion and diversity are essential to our culture and values. We focus on fairness and opportunity for all – across race, ability, ethnicity, gender, age, sexuality, cultures and beliefs – that reflect the communities we work in. At Epworth, we care.

Responsibilities

The Health Fund Compliance Coordinator will support the Health Fund Contract Manager in ensuring hospital claims comply with health fund contracts. This includes reviewing health fund audits, analyzing claims against clinical documentation, and liaising with various departments to facilitate payment of outstanding accounts.