Mater Heath has a newly created permanent, and full-time Private Health Insurance Audit Manager position which will see you coordinate and manage the Mater private health fund audit process. You will be the subject matter expert on health fund contracts and business areas associated with audits and billing along with clinical matters relating health fund audit request such as, but not limited to, prosthesis, critical care certificate, rehabilitation episodes, mental health episodes, acute clinical episodes, and certificates.

Reporting to the Senior Manager Revenue Assurance, this role will see you work across both our South Brisbane and Newstead locations and may also see you travel to our other locations across Queensland.

Salary range: $62.98 - $67.59 per hour plus superannuation and access to not-for-profit salary packaging up to $15,900

What you’ll be doing

Typical duties of the role include:

• Manage all PHI audit requests including on-site audits and report outcomes to key stakeholders
• Provide timely responses to all health fund audit requests as per the HPPA
• Utilisation of a detailed knowledge and understanding of all health fund contracts to interpret and challenge the fund audits
• Provide detailed analysis of financial risk relating to PHI audit
• Analyse historical audit data to provide an accurate financial risk assessment for future audits
• Identify issues and themes relating to audits and provide feedback and education to stakeholders to address problem areas and implement process improvement
• Review retrospective data for the purpose of rebilling for additional funds
• Initiate and conduct internal audits to identify risk areas
• Review current processes and recommend and/or implement quality improvements
• Provide a high-level analysis and reporting of audit outcomes
• Provide support and education to key personnel in all Mater facilities.
• Provide support and assistance to other team members.
• Review and compile documentation for the purpose of education and training and reporting

About you

We are searching for someone who has:

• Tertiary qualifications in clinical, business related or human behaviour related disciplines
• MBA, Master Health Administration, or other relevant post-graduate level qualifications would be highly regarded
• Minimum 3 years' clinical experience in a medical, nursing, or allied health discipline
• Experience in a private healthcare billing department or PHI contract management would be highly regarded
• Demonstrated experience in managing and reviewing Health Fund billing queries
• Experience in interpreting Health Fund contractual obligations and associated billing rules
• Demonstrated advanced level of knowledge of the funding models for private health care
• Strong understanding of clinical terminology
• Strong organisational skills and capable of working on multiple tasks
• Strong attention to detail
• Able to work autonomously and as part of a team
• Strong relationship and interpersonal skills
• Strong skill level in use of Excel spreadsheets
• Possess a detailed knowledge and understanding of State and Commonwealth legislation
• Thorough knowledge of the billing process and procedure for privately funded inpatients.
• Highly developed problem solving and analytical skills

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
• 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
• Unlimited access to a multitude of discounted fitness facilities through Fitness Passport
• Access to on-site, discounted parking
• Discounted food and beverage at various campus cafés and coffee venues
• Access to gym, pool and end of trip facilities within our new purpose-built corporate office in Newstead

For further information please contact Regan Dent – Revenue Optimisation Manager on regan.dent@mater.org.au

 Applications close on 26th of June 2024. Please note, we may contact applications prior to the closing date, please do not hesitate to APPLY NOW!

Mater is committed to the wellbeing of their staff, and it is underpinned by our flexible and remote working policies.

Please Note: We will not require any support from Recruitment Agencies at this time and kindly request no contact is made. Only direct applications will be considered.