National Manager, Payor Audit
Vor 7 Tagen
National Manager, Payor Audit & Assurance Full time
The National Manager, Payor Audit and Assurance will play a key role in driving Ramsay Health Care Australia's strategic and operational success, partnering with hospital executives, payors, and industry leaders.
You will lead the audit process, analytics, and the Revenue Assurance team, while providing strategic insights and operational support to peers and executives, ensuring Ramsay's continued excellence as an integrated health services leader.
This role can be based in Queensland, New South Wales, or Victoria.
About You
To succeed in this role, you'll need strong leadership, a strategic mindset, and the ability to collaborate with executives, payors, and industry leaders, ensuring excellence in revenue assurance and operational support.
Key Accountabilities
Contribute to the negotiation of priorities, principles, and strategic objectives for the Payor Contracting function.
Manage and coordinate internal/external billing and coding audits, ensuring compliance.
Monitor the performance of contracts, focusing on optimising revenue and managing risks.
Develop and execute plans to mitigate risks and capitalise on opportunities in payor contracts.
Oversee day-to-day operations to ensure compliance with billing and coding requirements.
Manage the electronic claims adjudication rules engine (RTAP) and provide detailed reporting.
Lead the Clinical Documentation program to ensure ongoing success and compliance.
Provide leadership and industry representation, managing stakeholder relationships across payors and executives.
Support the design and implementation of initiatives that improve coding accuracy, reduce insurer audit recoveries, and optimise revenue.
Identify and drive continuous improvement opportunities to enhance efficiency, effectiveness, and profitability.
Your Skills and Experience
Advanced relationship management, consultation, influencing, and negotiation skills, fostering collaboration with diverse stakeholders.
In-depth understanding of the private health industry macro environment, including the challenges and opportunities for hospital operators.
Tertiary qualifications in a health-related discipline or health information management, with relevant experience in the field.
Comprehensive knowledge of revenue operations within large, complex organisations, including understanding key financial drivers, risks, and cost challenges.
Proven experience in leading and managing high-performing teams, driving results through effective leadership.
Strong analytical skills to systematically assess complex issues, develop actionable solutions, and prioritise initiatives.
In-depth understanding of healthcare contracts, with the ability to navigate and manage contractual obligations.
Practical knowledge of various funding models and health case mix protocols, ensuring alignment with operational and financial goals.
About Ramsay Health Care
Founded in Australia in 1964, Ramsay Health Care is the nation's largest private hospital operator and a leader in global healthcare excellence.
With 73 state-of-the-art hospitals and surgery centres, we serve over 1.1 million patients annually, supported by a team of more than 30,000 professionals across Australia.
Our ethos, " People Caring for People ," reflects our commitment to exceptional patient care, strong relationships, continuous improvement, and sustainable growth.
To Apply
All applications should include your CV outlining your experience and skills in line with the above criteria.
Applications close Thursday 12th December 2024.
Ramsay Health Care is committed to Child Safety.
Details of our commitment are set out in our Code of Conduct, available at www.ramsayhealth.com .
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