Health Information Manager

*Lorica Health is now part of Cotiviti.  This role will be based in Lorica's office in Sydney, Australia or fully remote*

Lorica Health is currently seeking a Health Information Manager for an exciting opportunity at a leading digital health SaaS company.  We are looking for a Health Information Manager to work alongside a talented team of data scientists, analysts and engineers.

Our passionate team of data scientists, software engineers and domain experts build global products which apply advanced analytics to healthcare data in order to target fraud, abuse, waste, and errors. This is complemented by our Payment Integrity Practice which uses our proprietary product, HIBIS, to detect fraud, abuse and errors on behalf of clients. We serve over 30 private and public health sector clients across the world.

Description:
As Health Information Manager (5+ years’ experience) you will lead Lorica’s Payment Integrity Practice that provides outsourced claims audit and recoveries services.  You will be responsible for helping clients identify and recover overpayments as well as providing support, guidance and training. This role provides a variety of experiences across payment integrity and within Lorica.  It is key to Lorica’s customer success and reports to the Head of Customer Experience and Partnerships.

Responsibilities:

• Lead
  • The Recoveries Service for Lorica to drive customer value and revenue
  • The development of key stakeholder relationships internally and externally
  • The growth and evolution of the Recoveries Service in line with Lorica’s strategy
• Recoveries
  • Deliver value to clients by leveraging your knowledge and experience to assess alerts in our proprietary system, HIBIS, to identify potential overpayments
  • Manage the qualification and recovery process on behalf of clients including:
    • Reviewing surrounding data in the client’s operating system to qualify the alert and calculate potential overpayment
    • Liaising with key contacts at hospital providers to review supporting documentation and handle objections
    • Represent the client in assessing whether a repayment is due
    • Follow up with hospitals until any overpayment is repaid
  • Training, support and promotional activities
    • Deliver training to employees of clients (as required)
    • Support and assist with facilitation of HIBIS user forums (and other training or promotional events as required)
    • Provide timely, professional and supportive responses to client enquiries
    • Represent Lorica at industry events and conferences
    • Provide timely advice and support to internal and external stakeholders
  • Product development
    • Provide insights into hospital or medical billing practices to the product teams
    • Suggest new rules or enhancements to existing rules within HIBIS to drive further value for clients and reduce the incidence of false positives (incorrect alerts)
    • Identify product enhancements and features to further develop user experience
  • Stakeholder relations
    • Manage and maintain strong relationships with clients, hospitals, industry bodies and other key stakeholders
    • Provide outstanding customer service to clients
  • Business development
    • Support the Head of Customers and Partnerships with business development initiatives (as required)
  • Confidentiality
    • Strictly respects the confidentiality of all sensitive company and client information
  • Personal development
    • Maintain currency of knowledge and experience applicable to the role including, but not limited to, ICD-10-AM coding, DRGs and private hospital funding models
    • Meet any requirements (including mandatory professional development) to retain accreditation/s applicable to the role

Required qualifications:

• University degree in Health Information Management or equivalent
• Certificate in clinical coding auditing (highly desirable)
• Holds full membership with the Health Information Management Association Australia

Desired skills/experience:

• Coding and casemix experience (preferably including a private hospital context)
• Demonstrated understanding of private hospital funding models
• Clinical coding audit experience
• Experience working in Private Health Insurance (highly desirable)
• Experience in handling Private Health Insurance contracts and billing procedures

Role specific characteristics:

• Excellent written and verbal communication skills
• Dynamic approach to managing multiple customers and their associated accounts, access points and inboxes
• Inquisitive by nature
• Is a self-starter
• Ability to work both independently (remotely from home office) and as part of a team
• Proactive, accountable for resolving issues or client concerns and a demonstrated passion for continuous improvement
• High attention to detail, accuracy and highly proficient time management skills
• Ability to travel (both nationally and internationally) as required

What do we offer?

• A flexible and inclusive working environment
• The opportunity to make a difference in healthcare
• A learning and growth environment

The right candidate will be rewarded with a fun and friendly culture and a competitive remuneration package.

If a dynamic role in the health tech space is what you’re seeking, please submit a cover letter and CV to careers@loricahealth.com for consideration.

About Lorica Health

At Lorica Health we power better healthcare by enabling transparency in healthcare markets.

Our passionate team of data scientists, software engineers and domain experts build global products which apply advanced analytics to healthcare data in order to target fraud, abuse, waste, and errors.

Lorica is now part of Cotiviti, a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value.