Prosthesis Clinical Analyst
Brisbane, Australia
Prosthesis Clincal Analyst
At Bupa, purpose meets possible. Join us and help shape a future where healthcare is more connected, more personal and more human.
We’re a global healthcare leader trusted by millions and committed to helping people to live longer, healthier, happier lives and making a better world. Healthcare is changing, and so are we. We’re investing in more clinics, better systems and smarter, more connected ways to help our customers. As we continue to expand our services and invest in innovation, you’ll help create a healthcare system that meets people where they are, responds to what they need and leaves them better than before.
Here, your work has purpose, your voice matters and your future is full of possibility.
Just imagine the impact you could make.
The purpose of this job:
To ensure hospital cost savings as a result of developing and implementing claims leakage strategies, system rule improvements and controls; undertaking hospital contract compliance activities (including the conduct and management of onsite and desktop provider audits); and validating provider billing and coding practices.
What you’ll need to make it possible
- Registered Nurse eligible for registration in Australia (Operating Theatres – Scrub/Scout) and/or Medical Device Company clinical support experience.
- Relevant tertiary qualifications in nursing and/or health information management
- Proven experience in a major hospital with significant exposure to Operating Theatres and Implantable Prosthesis Management
- Understanding of clinical coding impacts upon Diagnosis Related Groups (DRGs)
- Understanding of hospital casemix concepts in the Private Health Insurance setting.
- Understanding/experience of auditing and claims in a health insurance environment.
- Private Health Insurance work experience.
- Understanding of private hospital contract management
What you’ll be doing in this role:
- Initiate, manage and finalise hospital, clinical, provider, and member profiling reviews within an agreed annual work program.
- Arrange and conduct regular onsite and desktop provider audits, manage end to end processes including follow up and financial management of incorrect billing
- Review the specific detail of hospital claims to advise where there are incorrect or inappropriate coding/ billing practices
- Validate provider initiated DRG review requests based on coding and documentation analysis
- Provide clinical/coding standards advice on statistical reports produced by Data and Claims Analysts to determine if further investigation and action is warranted.
- Initiate, write, develop, and continually improve relevant data reports to identify areas of actual and potential claims leakage based on Bupa Hospital and Medical contracts,
- Legal and regulatory compliance, adherence to internal operating procedures, together with the management of business risks is the responsibility of every Bupa employee.
Why you’ll love it?
We support our people to be the healthiest and happiest versions of themselves.
If this sounds exciting, we’d love to hear from you. Let’s shape the future of healthcare, together.
At Bupa your wellbeing, identity, and personal story are respected and valued. We are continuing to build teams that reflect the diversity of the communities we serve. Bupa is committed to providing equal opportunities and fostering a workplace and environment that is free of discrimination, bullying and harassment.
We actively encourage applicants from all backgrounds and experiences, including Aboriginal and Torres Strait Islander peoples, veterans, people with disabilities, and LGBTQIA+ applicants.
We are dedicated to removing barriers to participation. If you need any reasonable adjustments during the recruitment process, or if you’d like to discuss how this role can be flexible for you, please let us know so we can support your participation on an equitable basis.
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