Clinical Coder / Health Information Manager

We are looking for a Clinical Coder/ Health Information Manager to come and join our Benefits Assurance Team, in our Surry Hills head office. Working closely with the Payment Integrity team, you will ensure that the claims being lodged by providers on behalf of Teachers Health members are appropriate by conducting analysis and identification of coding, DRG and documentation anomalies.

What we have to offer?

• 6 weeks of annual leave
• Hybrid working model
• Subsidised private health insurance and discounts on our products and services
• Located in a modern and bright office setting in Surry Hills, close to Central Station
• Employee well-being programme
• An annual corporate wardrobe allowance

Who are we?
Teachers Health, was created by teachers for teachers over 65 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 360,000 teachers, education staff & their families.

What we need from you:

• Completion of a recognised clinical coding course (HIMAA, OTEN) or relevant tertiary qualifications
• At least 3 years’ experience in a similar role
• Experience in coding auditing

Overview:

• Conduct audits to ensure compliance with Australian Coding Standards, hospital contracting arrangements and industry guidelines.
• Provide advice on DRG, clinical coding and coding queries to support decisions on hospital and medical claim payments
• Experience in coding auditing in broad casemix

Some of your key responsibilities would be:

• Undertake auditing of claims, focusing on coding and DRG audits using daily reporting tool, HIBIS and escalations from internal teams;
• Analyse claims data and identify inconsistent/outlier episodes;
• Review error DRGS such as 801A, 801B & 801C, 901Z etc
• Review DRG change requests and follow up with hospital where more information is required and as appropriate
• Undertake desk or onsite audits when appropriate and report findings;
• Monitor data (e.g. HAMBS and HIBIS) to identify, report and react to inappropriate billing practices of providers and members;
• Design and review reasonability rules applied through the HAMBS System to reduce overpayment due to inappropriate claiming;
• Educate and report on finding around coding and DRG issues to the relevant staff (specifically claims assessors);
• Monthly reporting of key activities

If you are interested in joining our welcoming and supportive team, then hit APPLY and we can set up a confidential chat!

We welcome all suitably qualified applications, and we encourage people with a disability to apply for roles and to request any support or reasonable adjustments that may be required to fully participate in the recruitment process.

All candidates must be willing to undertake national police check as part of our recruitment process