Job Title

Join to apply for the Hospital Claims Auditor role at Teachers HealthHospital Claims Auditor - 12-Month Fixed-Term ContractYou''ll be responsible for ensuring that claims submitted by Hospital providers on behalf of members comply with internal fund rules and AHSA contract guidelines.Using HIBIS and other reporting tools, the role will liaise with contacts at Hospitals to validate flagged claim anomalies, and work with internal claims assessors to educate on processing issues leading to benefit leakage.What we have to offer?Attractive leave benefitsHybrid working model (flex your work/life balance)Subsidised private health insuranceDiscounts on our products and servicesGenerous employee wellbeing programEasily accessible by public transportWho are we?Teachers Health was created by teachers for teachers over 70 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 400,000 teachers, education staff & their families.What will you do?Daily review of alerts in claim auditing tool HIBIS. Work within settlement terms to prevent release of payment for claims flagged with billing anomalies. Complete ''stop payment'' processes within the system where appropriate.Regular review of HIBIS alerts that have fallen outside of payment settlement terms. Prepare audit batches and liaise with Hospital staff to review anomalies and recover leaked benefits.Liaise with the Clinical Coding Auditor to review clinical scenarios and coding issues flagged through various audit activities.Completion of regular control processes around payment duplication and quality assurance. Provide feedback and recommendations to stakeholders when issues are identified.Complete refund request and payment allocation processes in the system for any recoverable amounts identified across various audit types.Provide ongoing education to claims assessors on processing issues that are identified during various audit activities.Review, develop and update relevant policies and procedures and assist with identifying areas where processes may be streamlined and improved.What do you need?Experience in claims/benefits assessment within private health insurance, or healthcare billing/revenue assurance rolesStrong Microsoft Excel skillsHigh attention to detail and strong organisational/time management skillsExcellent written and verbal communication skillsStakeholder management experienceGeneral understanding of the Australian healthcare landscapeKnowledge of medical terminologyExperience with HAMBS or similar systems (desirable)How do I apply?Click APPLY NOW to submit your updated CV, along with an optional cover letter or a 60-second introduction video sharing why you''d be a great fit for the role.Teachers Health values diversity and inclusion and encourages applications from people with diverse backgrounds including First Nations people, people with disability, people from diverse cultural and linguistic backgrounds, and people that identify as LGBTQIA+. Applicants can request an adjustment at any stage during the recruitment process by getting in touch with [email protected] #J-18808-Ljbffr