Professional Summary
HIMAA-certified Senior Medical Coder and Billing Specialist with extensive experience managing complex inpatient Casemix, day surgery, and outpatient classifications across Sydney private and public healthcare settings. Recognized for high-level accuracy in AR-DRG assignment, rigorous application of Australian Coding Standards, and comprehensive revenue cycle oversight across Medicare, DVA, and private health funds.
Professional Experience
Bennelong Private Hospital
Sydney, Australia
Lead Clinical Coder and Billing Specialist
Apr 2020 – Present
- Lead a team of six clinical coders auditing acute inpatient, day surgery, and subacute episodes across 240 registered beds.
- Oversee complex case coding using ICD-10-AM, ACHI, and Australian Coding Standards (ACS) to ensure accurate AR-DRG assignment.
- Collaborate with clinical documentation improvement teams to resolve physician documentation queries, reducing unbilled claim backlogs by 35%.
- Direct inpatient billing operations across Medicare, Department of Veterans Affairs (DVA), and private health funds via ECLIPSE, maintaining a 98.5% first-pass claim rate.
- Perform quarterly Casemix and WIES/NWAU variance analyses to support hospital executive reporting and revenue cycle integrity.
Waratah Bay Healthcare Network
Sydney, Australia
Senior Clinical Coder
Aug 2015 – Mar 2020
- Extracted, abstracted, and coded multi-day surgical, medical, and ICU records in compliance with national and NSW Health standards.
- Managed complex billing disputes and rejected claims with statutory third parties, including State Insurance Regulatory Authority (SIRA) and private insurers.
- Mentored junior coding staff and conducted monthly peer-review audits to maintain coding accuracy above 96%.
- Identified systemic documentation gaps in orthopaedic and cardiology summaries, leading to streamlined clinical query protocols.
Ku-ring-gai Specialist Medical Centre
Sydney, Australia
Medical Coder and Billing Officer
Feb 2011 – July 2015
- Coded outpatient procedures, consultations, and day-stay admissions using ICD-10-AM and the Medicare Benefits Schedule (MBS).
- Processed electronic batch claims via Medicare Online and generated patient invoices for gap-cover and non-cover accounts.
- Audited patient charts for billing compliance, reducing aged accounts receivable over 90 days by 22%.
Education & Qualifications
TAFE NSW
Diploma of Health Information Management · Health Information Management · Sydney, Australia · Distinction · Feb 2009 – Dec 2010
Completed comprehensive training in ICD-10-AM, ACHI, ACS, health data management, medical terminology, and Australian Casemix systems.
Projects
Electronic Medical Record Coding Integration
Feb 2023 – Nov 2023
- Led the configuration, data mapping, and validation of updated ICD-10-AM and ACHI code sets during the hospital-wide migration to a modern digital health record.
- Developed standardized query templates for clinicians, resulting in a 40% reduction in query turnaround intervals during transition.
Core Competencies
ICD-10-AM & ACHI
Australian Coding Standards (ACS)
AR-DRG Assignment
Medicare Benefits Schedule (MBS)
ECLIPSE & Health Fund Claiming
Clinical Documentation Improvement (CDI)
Casemix & Revenue Cycle Management
Patient Administration Systems (PAS)
Statutory Compliance & Auditing
Medical Terminology & Pathology
Languages
English
C2
Certifications & Accreditations
Certified Clinical Coder (CCC)
Health Information Management Association of Australia (HIMAA) · June 2016
Certificate in Clinical Classification
Health Information Management Association of Australia (HIMAA) · Nov 2011