Health Fund Audit and Assurance Lead
Core
Lead a small team to conduct health fund audits, identify revenue discrepancies, and ensure compliance with payer guidelines to optimize hospital revenue.
Role type
Senior IC Health Fund Audit & Assurance Lead
Builds
Audit reports, trend analyses, and corrective action plans for billing and eligibility issues
Domain
Healthcare administration / Private health insurance / Revenue assurance
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Health fund audit experience, revenue assurance, contract interpretation, team leadership, data analysis, compliance monitoring, stakeholder engagement, Microsoft Excel
Preferred skills
Acute hospital billing knowledge, ICD-10 coding, MBS items, Queensland Health HCP data validation, medical terminology, Certificate III in Business Administration
Technologies
Microsoft Excel, Microsoft Office applications
Responsibilities
Lead desktop and onsite health fund audits, establish best practice audit processes, analyze audit trends to identify revenue opportunities, provide training on compliance requirements, collaborate with coding and billing teams, monitor and action data validation errors
Seniority
Senior, hands-on IC with team leadership