Job Description Supporting the Health Fund Contract Manager to ensure that hospital claims comply with health fund contracts and provide advice on health fund claim audits and other contract issues, your primary responsibilities will be to review/process health fund audits, analyse health fund claim audits against clinical documentation and health fund contract clauses, and liaise with Patient Revenue, clinical coders and other operational management as necessary to determine agreement (or not) with the health fund audit request. Your ability to deliver well-reasoned and evidence-based responses will enable clear communication of audit outcomes to health fund auditors and Epworth divisional management, while identifying opportunities to improve processes related to health fund audits and billing practices. Strong collaboration and relationship-building skills will support Patient Revenue in reviewing and assessing the collectability of unpaid health fund accounts, including providing clinical information to facilitate payment. Additionally, you will help identify opportunities for revenue optimization and ensure contract compliance. You will make an impact by: Supporting Patient Revenue in reviewing and assessing the collectability of unpaid health fund accounts, including the provision of clinical information to health funds to support the payment of those accounts. Liaising with operational divisions, as required, to obtain the necessary information to support the payment of outstanding accounts. Identifying audit trends and opportunities for process improvements to reduce the volume/impact of future audits. Identifying opportunities for revenue optimisation and contract compliance.
