Clinical Coding Auditor

Teachers Health; Sydney; Hybrid; AUD 85,000 - 110,000; Full time

Benefits offered by this job

Hybrid working model

Subsidised private health insurance

Attractive leave benefits

Discounts on products and services

Generous wellbeing program

Easy access by public transport

Job summary

Teachers Health is seeking a Clinical Coding Auditor to ensure hospital claims are accurate, fair and compliant, protecting members and funds. You will investigate complex claims, identify anomalies, and collaborate with providers and internal teams to improve billing and payment outcomes.

The role emphasizes reviewing DRG accuracy, data analysis, and providing expert guidance to claims teams, with a hybrid work model and strong stakeholder engagement.

Qualifications

• Completion of a recognised Clinical Coding qualification (HIMAA, OTEN or equivalent).
• Minimum 3 years' experience in clinical coding within a tertiary hospital environment.
• Experience auditing clinical coding and DRG assignments.
• Strong understanding of Australian Coding Standards, ICD-10-AM and DRG methodologies.

Responsibilities

• Review hospital claims and clinical documentation to ensure coding and DRG accuracy.
• Identify unusual billing patterns, errors and opportunities to prevent overpayments.
• Partner with hospitals to resolve coding queries and investigate complex claims.
• Provide expert advice and guidance to claims teams on coding and funding matters.
• Analyse data and trends to improve payment integrity and support business decisions.
• Conduct audits and communicate findings to key stakeholders.
• Contribute to process improvements that enhance claim accuracy and efficiency.

Skills

Clinical coding

HIMAA/OTEN or equivalent

ICD-10-AM

DRG methodologies

Excel

Data analysis

Stakeholder management

Education

Recognition Clinical Coding qualification (HIMAA, OTEN or equivalent)

Tools

HAMBS

Job description

Do you have a sharp eye for detail and a passion for clinical coding accuracy? Join Teachers Health as a Clinical Coding Auditor and play a key role in ensuring our members receive the right benefits while maintaining the highest standards of coding integrity and payment accuracy. Working across hospital claims, clinical documentation and funding models, you’ll use your expertise to investigate complex claims, identify coding anomalies, and provide valuable insights that help protect our members and our fund.

What we have to offer?

We at Teachers Health have a lot to offer,

• Attractive leave benefits
• Hybrid working model (flex your work/life balance)
• Subsidised private health insurance
• Discounts on our products and services
• Generous employee wellbeing program
• Easily accessible by public transport

Who are we?

Teachers Health was created by teachers for teachers over 70 years ago and is the only health fund exclusively for the education community. As a not-for-profit health fund, we exist for our members covering the lives of over 500,000 teachers, education staff & their families.

What will you do? / How will you help?

As our Clinical Coding Auditor, you’ll help ensure hospital claims are accurate, fair and compliant, protecting both our members and the fund. You’ll use your clinical coding expertise to investigate complex claims, identify anomalies and work closely with providers and internal teams to drive better billing and payment outcomes.

You Will

• Review hospital claims and clinical documentation to ensure coding and DRG accuracy
• Identify unusual billing patterns, errors and opportunities to prevent overpayments
• Partner with hospitals to resolve coding queries and investigate complex claims
• Provide expert advice and guidance to claims teams on coding and funding matters
• Analyse data and trends to improve payment integrity and support business decisions
• Conduct audits and communicate findings to key stakeholders
• Contribute to process improvements that enhance claim accuracy and efficiency

What do you need? / What are we looking for?

Essential

• Completion of a recognised Clinical Coding qualification (HIMAA, OTEN or equivalent)
• Minimum 3 years' experience in clinical coding within a tertiary hospital environment
• Experience auditing clinical coding and DRG assignments
• Strong understanding of Australian Coding Standards, ICD-10-AM and DRG methodologies
• Experience interpreting complex clinical documentation and applying coding guidelines accurately
• Advanced Microsoft Excel skills and confidence analysing data
• Knowledge of public and private hospital funding models
• Strong analytical and investigative skills with the ability to identify inconsistencies and resolve complex issues
• Excellent stakeholder management and communication skills

Desirable

• Advanced Clinical Coding Certificate
• Experience within the private health insurance industry
• Exposure to HAMBS or similar health insurance claims systems
• Experience working with hospital claims auditing, payment integrity or benefits assurance functions

Teachers Health values diversity and inclusion and encourages applications from people with diverse backgrounds including First Nations people, people with disability, people from diverse cultural and linguistic backgrounds, and people that identify as LGBTQIA+. Applicants can request an adjustment at any stage during the recruitment process by getting in touch with [e-mail]