Health Information Manager

Australian Unity Limited; Melbourne; Sur place; AUD 120 000 - 160 000; Plein temps

Avantages offerts par ce poste

Competitive salary

Bonus program

Parental leave (14 weeks)

Employee referral program

Employee Assistance Program

Well-Being and Community leave

Learning & development access

Résumé du poste

Australian Unity Limited is seeking an experienced Health Information Manager to join the Insurances team. You will review hospital and medical claims, applying coding standards to verify accuracy and support appropriate documentation.

You will conduct pre- and post-payment reviews, assist audits, and drive improvements in rules, workflows and guidance. The role requires specialist knowledge of ICD-10-AM/ACHI and Australian Coding Standards, with a focus on casemix, hospital documentation and

Qualifications

• Qualified Health Information Manager with strong clinical coding knowledge.
• Experience interpreting complex medical records and hospital claims.
• Demonstrated ability to audit, analyze and improve claims processes.

Responsabilités

• Review hospital and medical claims, conducting targeted pre- and post-payment reviews.
• Apply coding expertise to ensure alignment with ICD-10-AM/ACHI, DRGs and MBS requirements.
• Support provider audits by reviewing documentation and identifying overpayments or non-compliant claiming.
• Provide specialist guidance on clinical coding, casemix and hospital documentation.
• Engage with hospitals, providers and internal teams to validate findings and resolve claims matters fairly.
• Identify patterns to improve claims rules, alerts, workflows and guidance.
• Maintain audit records of decisions, reviews, recoveries and savings.
• Share knowledge to strengthen coding capability and payment accuracy across the business.

Connaissances

Clinical coding

Health information management

Data analysis

Stakeholder communication

Auditing

Documentation

Formation

Bachelor/degree in Health Information Management

Outils

ICD-10-AM/ACHI

Australian Coding Standards

Description du poste

Established in 1840, we are Australia's first wellbeing company, delivering health, wealth and care services for our members and the community.

As a social enterprise, we're motivated by our purpose to positively impact the wellbeing of millions. We reinvest profits to deliver products and services sustainably that matter most to our members, customers and the Australian community.

For us, Real Wellbeing encompasses the whole experience of life. It's about feeling supported in your health, connected with your community and empowered to live life on your terms.

About the Opportunity

We're looking for an experienced Health Information Manager to join our Insurances team.

Reporting to the Head of Strategic Enablement, you'll use your health information management and clinical coding expertise to review hospital and medical claims, helping ensure hospitals are paid accurately and claims are supported by appropriate clinical documentation and coding.

This is an opportunity to combine technical coding expertise with audit, analysis and continuous improvement. You'll conduct targeted pre- and post-payment reviews, support provider audits and recovery activities, and identify recurring trends that can improve claims rules, guidance and processes.

What you'll do:

• Review hospital and medical claims: Conduct targeted pre- and post-payment reviews of complex, high-value and higher-risk claims, assessing coding, clinical documentation and claiming practices.
• Apply your coding expertise: Determine whether claims align with Australian Coding Standards, ICD-10-AM/ACHI, Diagnosis Related Groups, Medicare Benefits Schedule requirements, prostheses arrangements and relevant fund rules.
• Support audits and recoveries: Contribute to provider audits by reviewing documentation, recording findings and identifying potential overpayments, upcoding or non-compliant claiming.
• Provide specialist advice: Support Claims Integrity and operational teams with practical guidance on clinical coding, casemix, hospital documentation and complex claims matters.
• Engage with providers and stakeholders: Work with hospitals, healthcare providers and internal teams to validate findings and resolve claims matters fairly, consistently and accurately.
• Identify opportunities for improvement: Analyse recurring coding, documentation and claiming patterns and contribute to improved claims rules, alerts, workflows and guidance.
• Maintain clear audit records: Document evidence-based decisions and maintain accurate records of claims reviews, audit activity, recoveries and identified savings.
• Share knowledge: Provide technical support and knowledge sharing to colleagues, helping strengthen coding capability and payment accuracy across the business.

About You

You're a qualified Health Information Manager with strong clinical coding knowledge and the ability to interpret complex medical records and hospital claims.

Analytical and detail-oriented, you're comfortable making evidence-based decisions and clearly documenting your findings. You can explain technical information to non-technical stakeholders and enjoy identifying practical ways to improve accuracy, processes and outcomes.

You will bring:

• A tertiary qualification in Health Information Management, or an equivalent recognised qualification
• Demonstrated clinical coding experience and current knowledge of ICD-10-AM/ACHI and the Australian Coding Standards
• Sound knowledge of Diagnosis Related Groups, casemix and hospital clinical documentation
• Experience reviewing complex medical records, coding or claims and documenting clear, defensible findings
• Strong analytical skills, attention to detail and sound professional judgement
• The ability to manage competing priorities and complete quality reviews within agreed timeframes
• Clear written and verbal communication skills, including the ability to explain technical findings to different audiences
• A collaborative approach and the ability to work effectively across multidisciplinary teams
• A continuous improvement mindset and an interest in strengthening claims accuracy and audit processes

Experience within private health insurance or a private hospital environment will be highly regarded, particularly where you have worked across clinical coding, provider audits, payment integrity, hospital contracting or claims recoveries. Knowledge of the Medicare Benefits Schedule, prostheses arrangements, hospital funding or claims analytics would also be advantageous.

Applications will close on Wednesday, 28 October 2026.

Why Join Us?

You will enjoy a range of great employee benefits and rewards including:

• Competitive salary + bonus program
• Enjoy additional yearly Well-Being and Community leave days
• 14-week paid parental leave, with equal benefit for both parents
• Employee Referral Program
• Employee Assistance Program - support and assistance for you and your partner at those times in life when you need it most
• Flare/Maxxia Rewards - a great range of discounts and benefits at selected retail outlets, department stores, attractions, travel, cinemas, restaurants.
• Discounts across the Australian Unity business including Private Health Insurance, General Insurance + more!
• Available access to LinkedIn Learning courses through our great Learning platform

For further benefits visit: https://www.australianunity.com.au/careers/culture

Australian Unity is an Equal Opportunity employer and we encourage applications from all members of the community, including people of Aboriginal and Torres strait Islander descent, culturally and linguistically diverse backgrounds and, mature aged people.