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#523363
Full Time
Job Description
Doctors’ Health Fund is a restricted private health insurer; the only health fund in Australia that exclusively serves the medical community and their families. We are one of Australia’s fastest growing health funds and now cover more than 70,000 lives.
Proudly part of the Avant Mutual Group, Australia's leading Medical Defence Organisation, we are owned by doctors, not shareholders. We support the medical community by offering quality health cover and exceptional member service. We align our values to the profession by advocating for freedom of choice and clinical independence, while only supporting medically evidenced treatments and therapies.
We operate nationally with our head office in Sydney. As a wholly member-centric organisation, dedication to our members is embedded in our values, mission, people and culture.
Location for this role: Melbourne or Sydney
About the role:
The Health Information Manager is responsible for the integrity of all data, systems, and rules/alerts, used to accurately pay hospital and medical claims. The role will ensure compliance with legislative obligations, contractual agreements and coding standards of claims data and work closely with hospital and medical providers, to achieve a fair benefit payment for all parties.
Key accountability for the role:
Conduct detailed analysis and audit of hospital and medical claims data to identify potential leakage and to ensure the accurate payment of claims.
Regular communication with hospital and medical providers to convey Doctors Health Fund claiming requirements and to resolve any coding and claiming disparities.
Regular review of systems and rules to ensure they are suitable to Doctors Health Fund guidelines, legislative obligations, contractual agreements, coding standards and to ensure they provide a solid foundation in the accurate payment of claims.
Remain up to date with industry changes and trends and translate any new requirements into rules, alerts, process/procedure changes or staff education.
Provide regular detailed reporting on payment integrity activities that clearly show leakage categories, amounts and mitigating actions.
Support hospital and medical claims assessors with regular education on trends, industry changes, or potential issues to promote accurate up-front assessment of claims.
Experience and skills required:
Bachelor’s degree in Health Information Management.
Diploma of Clinical Coding or currently completing diploma.
At least 3 years’ experience working in a claim assessing role (hospital and medical) within a private health insurance fund.
Experienced in executing detailed analysis and audit with a payment integrity functions.
Experience in billing in a hospital or medical offices environment.
Ideally experience working within a clinical coding environment (preferred).
Experience working with the HAMBS platform (preferred but not essential).
Member of HIMAA (not essential).
At Avant, our people are the centre of everything we do for our members. We offer a range of benefits and opportunities to enable you to make a difference, learn, and grow in your career.
For more information, please contact Sue Allen, Talent Acquisition Business Partner on 042+ 404 856.
Other details
Pay typeSalary
Proudly part of the Avant Mutual Group, Australia's leading Medical Defence Organisation, we are owned by doctors, not shareholders. We support the medical community by offering quality health cover and exceptional member service. We align our values to the profession by advocating for freedom of choice and clinical independence, while only supporting medically evidenced treatments and therapies.
We operate nationally with our head office in Sydney. As a wholly member-centric organisation, dedication to our members is embedded in our values, mission, people and culture.
Location for this role: Melbourne or Sydney
About the role:
The Health Information Manager is responsible for the integrity of all data, systems, and rules/alerts, used to accurately pay hospital and medical claims. The role will ensure compliance with legislative obligations, contractual agreements and coding standards of claims data and work closely with hospital and medical providers, to achieve a fair benefit payment for all parties.
Key accountability for the role:
Conduct detailed analysis and audit of hospital and medical claims data to identify potential leakage and to ensure the accurate payment of claims.
Regular communication with hospital and medical providers to convey Doctors Health Fund claiming requirements and to resolve any coding and claiming disparities.
Regular review of systems and rules to ensure they are suitable to Doctors Health Fund guidelines, legislative obligations, contractual agreements, coding standards and to ensure they provide a solid foundation in the accurate payment of claims.
Remain up to date with industry changes and trends and translate any new requirements into rules, alerts, process/procedure changes or staff education.
Provide regular detailed reporting on payment integrity activities that clearly show leakage categories, amounts and mitigating actions.
Support hospital and medical claims assessors with regular education on trends, industry changes, or potential issues to promote accurate up-front assessment of claims.
Experience and skills required:
Bachelor’s degree in Health Information Management.
Diploma of Clinical Coding or currently completing diploma.
At least 3 years’ experience working in a claim assessing role (hospital and medical) within a private health insurance fund.
Experienced in executing detailed analysis and audit with a payment integrity functions.
Experience in billing in a hospital or medical offices environment.
Ideally experience working within a clinical coding environment (preferred).
Experience working with the HAMBS platform (preferred but not essential).
Member of HIMAA (not essential).
At Avant, our people are the centre of everything we do for our members. We offer a range of benefits and opportunities to enable you to make a difference, learn, and grow in your career.
For more information, please contact Sue Allen, Talent Acquisition Business Partner on 042+ 404 856.
Other details
Pay typeSalary
