Healthcare Management (HCM) has embarked on a program to evolve its Healthcare Insights Capability to support HCM commercial and operational teams more effectively and identify opportunities to connect with the Enterprise, allowing the HI business to respond quickly to emerging trends in healthcare and develop tools and enablers to support clinical, commercial, and member-targeted strategies.
Reporting to the Head of Healthcare Insights, the Clinical Coding Intelligence analyst is responsible for improving our understanding of healthcare data through a clinical coding lens to identify clinical trends and insights from our claims and alternative data sources.
This role is pivotal to the transformation of our analytics function to generate actionable insights that drive strategic decision-making across HCM teams, i.e., Hospital and Medical Partnerships, Ancillary and Claims Integrity as well as Connected Care and other Enterprise teams. This role will provide valuable insights into healthcare trends, cost drivers, and patient outcomes.
Key Responsibilities:Data Analysis: Use clinical coding intelligence to analyse large datasets, to identify trends, patterns, and anomalies related to healthcare costs, case-mix, utilisation, and outcomes. Support the development of risk adjustment tools for benchmarking purposes.Insights and Recommendations: Support the Healthcare Insights Teams to present complex data in a clear and actionable manner and translate data findings into actionable insights and strategic recommendations for stakeholders.Clinical Tools and Enablers: Embed robust clinical coding intelligence into our clinical tools that support ongoing HCM Strategies.Clinical Coding Crosswalks: Develop a suite of clinical coding crosswalks, facilitating the translation of codes between different classification systems, with the ability to adopt useful data assets from other markets, allowing data integration and migration, billing and reimbursement, clinical research and analysis, and participation in comparative studies.DRG Grouper Governance: Lead strategy development and implementation of ongoing management of Diagnosis Related Grouper (DRG) versions and the application to Bupa's funding models and claims system integration.Industry Engagement and Representation: Represent Bupa in industry-related engagements and working groups regarding clinical classification tools and DRG Grouper development.Communication and Collaboration: Present findings and recommendations to senior management and other key stakeholders. Work closely with IT and data management teams to ensure data integrity and system compatibility. Collaborate with cross-functional teams to develop data-driven strategies for improving member care and reducing costs.You may also carry out any other duties reasonably requested by Bupa from time to time.
To be successful in this role you'll need:Tertiary qualifications in Clinical Coding or Healthcare Information Management and/or Health Science field beneficial.Certified Professional Coder (CPC) or Coding Specialist (CCS).Minimum of 3-5 years of experience in clinical coding (preferably in a hospital environment), data analysis, with a strong understanding of coding systems in Australia i.e., ICD-10, ACHI and ACS, and coding in other global healthcare markets.Significant knowledge of healthcare data, clinical coding, case-mix principles, risk adjustment and the ability to build financial and benchmarking models.Proficiency in data analysis tools and software (e.g., SQL, SAS, Tableau, Excel, R and Python).Understanding of the Australian healthcare system and its ongoing reform.Experience with private healthcare sector and regulatory requirements.Proven capacity to communicate complex data insights clearly to technical and non-technical audiences.Proven capacity to work well independently and to collaborate with others, as required.Excellent analytical, problem-solving, and critical-thinking skills.Exceptional written and presentation skills and the ability to convert data into insight and prepare compelling, persuasive reports and presentations suitable for executive and board level content.Excellent time management skills.A track record of achievement and delivery.What's in it for you?As well as a competitive salary, a range of Bupa benefits and flexible working/work from home, you'll be challenged and encouraged to innovate. You will collaborate strongly with colleagues who are committed to delivering exceptional experiences.
Discount on our health insurance, travel, car, home, contents, and pet insurance products as well as Bupa services such as Dental and Optical.A 'People First' wellness program – SMILE. Provides a range of services such as health coaches, annual skin checks and flu vaccinations, assistance with nutrition, mental and general well-being guides, and product discounts.At Bupa, we are striving to create and sustain a safe and inclusive workplace. We welcome applicants from all cultural backgrounds, genders, and abilities. If you require any adjustments to participate in our recruitment process, please let us know at the time of your application.
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