Health Information Manager (Payments Integrity Officer)

Remarkable care - Remarkable career

Are you ready to rediscover remarkable and make a positive impact on people’s lives? At GMHBA, every day brings an opportunity to empower and support communities to live well. Join us to be part of something meaningful and discover the remarkable benefits of working at GMHBA.

In 2024 GMHBA will celebrate 90 years of operations, having originally formed to provide healthcare to Geelong cement workers and growing to become one of Australia’s largest regionally based health insurers. As a community-focused not-for-profit, we live and breathe exceptional care and are dedicated to making GMHBA a remarkable place to work. We value building connections, embrace individuality, and maintain a supportive, performing culture. GMHBA offers a flexible workplace, a community-focused culture, and a great regional lifestyle.

About the opportunity

We have an opening for an experienced Health Information Manager (HIM) with contemporary coding / audit and education skills to join our Benefits Management team. This is an ongoing role, full time or part time 0.8 FTE. Geelong based + hybrid working.

GMHBA are embarking on a CWO payment model, and this role supports our desire to expand the clinical practice of our Payments Integrity team. You’ll work with our existing Payments Integrity Officers to ensure that GMHBA pays the correct benefits of hospital claims.

You’ll be responsible for supporting the delivery of an effective and efficient billing and integrity program across hospital and medical claims submitted by providers and members, through comprehensive monitoring, auditing, and analysis of claims. You’ll assist the Payments Integrity Manager to ensure that the Fund pays the correct amount for health services in accordance with GMHBA’s legal, regulatory, and contractual obligations. The Qualified Health Information Manager provides technical guidance and knowledge regarding health data management and classification systems.

About you

As the ideal candidate you ‘ll be able to demonstrate the following skills and experiences

• Successful completion of relevant qualification and experience working in capacity of Health Information Manager/Clinical Coder or proven professional experience in Australian Health Industry working in hospital billing. Where qualified this will be recognised in the position title of the incumbent as Health Information Manager
• Demonstrated knowledge of private health sector funding model.
• Demonstrated knowledge of casemix protocols and application of this knowledge in the audit function.
• Experience working with PHI Hospital, Medical or Ancillary claim data.
• Able to read and understand claims data and clinical records with the ability to determine where inconsistencies and/or outliers have occurred.
• Confident oral and written communication skills.
• Ability to communicate ideas in both technical and user-friendly language.
• Effective time management, planning and organisational skills.
• Practical experience with reporting tools and relational data concepts.
• Relevant computer technical skills applicable to claim management and reporting, including Microsoft Office (Excel, Access, Word)
• Ability to build relationships and influence desired outcome.

Highly Desirable

• Practical experience with reporting tools and relational data concepts applicable to health data management and Classification systems.
• Knowledge of 3M Health Information Systems, Reports Manager, Rule Authoring Applications and data management software.

Let’s get started. 

Start your application by completing the form below.
Download the position description
Questions? Contact us at careers@gmhba.com.au

At GMHBA, we value a diverse and inclusive culture. We are committed to creating a workplace where every single person feels valued and can be their true, authentic selves. It allows us to be more reflective of our community, have a range of perspectives, and better support our customers, members, and patients. We encourage candidates with diverse backgrounds, experiences, perspectives, and beliefs to apply for this role.

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Please note, candidate screening and interviews may be conducted prior to the closing of the advertisement so get your application in as soon as possible.