Hybrid Clinical Coding Auditor: Payment Integrity & Claims

Teachers Health Fund; Sydney; Hybrid; AUD 90,000 - 120,000; Full time

Benefits offered by this job

Attractive leave benefits

Hybrid working model (flex your work/l

Subsidised private health insurance

Discounts on our products and services

Generous employee wellbeing program

Easily accessible by public transport

Job summary

Teachers Health Fund is seeking a Clinical Coding Auditor to ensure hospital claims are accurate and compliant, protecting members and the fund. You will review clinical documentation, DRG assignments and collaborate with hospitals to resolve coding queries.

The role requires a recognised clinical coding qualification and a minimum of three years in a tertiary hospital environment. Strong Excel and data analysis skills, plus excellent stakeholder communication, are essential.

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.
• 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.

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

Advanced Microsoft Excel

Data analysis

Analytical and investigative skills

Stakeholder management & communication

Education

Clinical Coding qualification (HIMAA, OTEN or equivalent)

Job description

Teachers Health Fund is seeking a Clinical Coding Auditor to ensure hospital claims are accurate and compliant, protecting members and the fund. You will review clinical documentation, DRG assignments and collaborate with hospitals to resolve coding queries.

The role requires a recognised clinical coding qualification and a minimum of three years in a tertiary hospital environment. Strong Excel and data analysis skills, plus excellent stakeholder communication, are essential.