Clinical Coding Auditor - Hybrid Role, Payment Integrity

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

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.