Private Health Insurance Audit Coordinator

Mater Group is currently seeking an experiencedPrivate Health Insurance (PHI) Audit Coordinator to join our Private Revenue team on a permanent full-time basis.

The PHI Audit Co-Ordinator reviews and coordinates Private Health Fund billing audits. The PHI Audit Co-Ordinator is required to identify practices requiring quality improvement and areas where the delivery of education and process re-engineering would benefit Mater.

Salary range:$42.05-$46.32 per hour plus superannuation and salary packaging

What you’ll be doing

• Review all health fund billing audits received by all Mater Private Hospitals
• Work closely with the PHI Audit Manager to determine if the recommendation for an audit episode is appropriate, and if not, take relevant steps to work with the health fund to resolve the situation
• Liaise and co-ordinate with relevant internal teams including Coding, Revenue Assurance, Billing and Privacy to obtain additional information required to perform the audit
• Make recommendations to the PHI Audit Manager and Revenue Operations Analyst where improvements are required based on results from audits
• Maintain the audit database so it is up to date and reflects the status of all audits being undertaken or completed
• Ensure that responses to the health funds are in accordance with instructions from the PHI Audit Manager
• Process audits within Key Performance Targets.
• Prepare internal requests on completion of an audit to assist in finalisation of the audit, including liaising with Accounts payable and the Billing Team
• Keep up to date with healthcare industry and legislation changes
• Keep up to date with renewed HPPA’s, interpretation of contractual obligations and associated billing rules
• Perform any other tasks as reasonably required by the Manager PHI Audit
• Follow processes and procedures in relation to the Audit Coordinator function

About you

To be successful, you will have demonstrated success in a similar role in a large and complex organisation coupled with the below:

• At least 3+ years' experience in a Private Healthcare billing department or experience in PHI contract management
• Demonstrated experience in managing and reviewing Health Fund billing queries
• Experience in interpreting Health Fund contractual obligations and associated billing rules and demonstrated advanced level of knowledge of the funding models for Private Health care
• An understanding of clinical terms, to assist in the review of claims
• Strong organisational skills and capable of working on multiple tasks
• Possesses a strong attention to detail
• Strong skill level in use of Excel spreadsheets

Why join us?

Mater is Queensland’s largest and most innovative not-for-profit healthcare service, providing care for almost 700,000 patients a year across a network of 11 hospitals.

We are a leader in healthcare, education and research — and that’s because we employ exceptional people. #MAKEYOURMATERMOVE

• Via salary packaging arrangements, allocate some living expenses directly from your pre-taxable income and ultimately increase your take-home pay
• Access to package meal and entertainment expenses via salary packaging
• Access to leading education and professional development via Mater Education
• Flexible working arrangements, including work from home options where suitable
• Access to our Employee Assistance Program and on-site pastoral care teams
• Discounts to local and national business/venues for Dining/Retail/Travel & Accommodation/Other
• Access to on-site, discounted parking
• Discounted food and beverage at various campus cafés and coffee venues

Applications close on Monday 26 February 2024.