Health Information Manager - Payment Integrity - Private Health Insurance

About Doctors Health Fund

Doctors Health Fund is a restricted private health insurer; the only health fund in Australia that exclusively serves the medical community and their families. We are one of Australias fastest growing health funds and now cover more than 70000 lives.

Proudly part of the Avant Mutual Group Australias leading Medical Defence Organisation we are owned by doctors not shareholders. We support the medical community by offering quality health cover and exceptional member service. We align our values to the profession by advocating for freedom of choice and clinical independence while only supporting medically evidenced treatments and therapies.

As a wholly membercentric organisation dedication to our members is embedded in our values mission people and culture.

About the role:

We are seeking an experienced Health Information Manager to assist in building the foundations of a robust Payment Integrity program within the organisation.

The role will assist in the formulation implementation and ongoing management of a comprehensive payment integrity audit program and will influence how our people processes and technology function to ensure the accurate disbursement of hospital and medical benefits.

About you:

Analytic and data focused approach: You have experience in the collection and analysis of claims data in order to identify patterns and trends that may indicate to inaccurate claims payments.

Communication and negotiation: You effectively communicate with stakeholders (internal and external) at all levels and have proven experience in negotiating conflicting interpretations to ensure a fair outcome for all parties.

Continuous improvement mindset: You proactively find ways to strengthen the prevention and detection controls and strive to improve processes to reduce false positives and process waste.

Strategic thinking skills: You proactively assess the payment integrity landscape through your network at conferences and via news/studies/papers to anticipate and communicate emerging trends and risks.

Key responsibilities

• Assist in the development implementation and the ongoing management of a hospital and medical audit program/framework to support the core functions of the Payment Integrity Team.
• Regularly communicate with providers to resolve any discrepancies related to claims data/supporting information to ensure the accurate payment of benefits.
• Identify opportunities across all Payment Integrity functions processes and controls to continually enhance people process and technology to ensure efficient and accurate methods of prevention and detection.
• Represent DHF in claims leakage committees/forums. Actively participate in these forums so that DHFs position is well understood and represented. Stay current on industry developments and changes and translate any new standards into rules alerts processes or procedures or to conduct staff training/education.
• Provide detailed and regular reporting of payment integrity activities savings volumes patterns etc.

Experience and skills required:

• Tertiary education qualification in Health Information Management.
• A minimum of 3 years working experience in a claims assessment position (hospital and medical) in a private health insurance fund.
• Experience in the implementation of payment integrity processes and controls.
• Hospital and medical billing experience in a hospital setting (desirable).
• Experience of working within a clinical coding environment (desirable).
• Experience of working with the HAMBS platform (desirable).

At Avant our people are the heart of all we do for our members. We provide benefits and opportunities for you to be your best learn and grow in your career.

For more information please contact Sue Allen Talent Acquisition Business Partner on.