Vicki Bakogianis

5:30 AM

On my day in the office,  I usually get up at 5:30 AM and get ready to leave home just after 6 AM to catch the tram to the city to get the train to work. Usually, I head into the office on a Wednesday for meetings and team catch-ups. On the other days I work from home – I get up a bit later and have time to do a workout and go for a run before I start my workday.

8:30 AM

The first thing I do when I log on is check my emails and go through the cases that have been assigned to me from HAMBS – our membership software that holds all the member data. 

When reviewing these cases I look to see why the case was sent to audit for review.  Today, I reviewed a case where there was a mismatch between what the hospital had billed us for a pace maker procedure, and the procedure’s coding that was on the invoice/HCP data. I then reviewed the contract between GMHBA and the hospital, and adjusted the claim by changing the amount that we are paying the hospital.  I then emailed the hospital to suggest what the correct payment should be and made sure to include a copy to our Claims team so that they can make the adjustment on the claim line.

In a typical day, I might also check claims to ensure that

• Intensive care unit and Critical care unit accommodation claims meet the criteria set up by the AHSA (Australian Health Services Alliance).
• Medicare Benefits Schedule items reflect the International Classification of Diseases/Australian Classification of Health Interventions coding
• Medical devices billed for are reflective of the actual procedures performed by the hospital

This work is extremely important to GMHBA because any claims ‘leakages’ that we identify are given back to our members – last year our team identified around $10 million of this type of ‘leakage’!

10:00 AM

This Wednesday, our whole Payments Integrity team meets with our internal ancillary auditors who look after our ‘Extras’ policies (dental, physio etc) – altogether, there’s about 12 of us so it’s a lot of fun.  On alternate Wednesday’s, our team meets with the hospital and medical auditor team. In these meetings we provide team updates, discuss any industry changes and new updates, and any interesting finds in our work.

11:30 AM

Usually, at this time I will have a quick catch-up with another Health Information Manager to discuss approvals – for example, mental health approvals that fall outside of the usual rate. I will check to make sure the information submitted is complete and that it is meeting any contractual criteria. Part of my role is to review extended intensive care, cardiac care, and mental health notification requests –  these are all very expensive claims! With mental health, we will pay up to 3 hospital admissions claims, so any more than these need to be checked with the provider.

1:30 PM

Lunch - if I’m in the office I will have dumplings with the team and then head across the road to Westfield to make my weekly Mecca purchase. If I’m working from home, I will go for a walk along the creek near my house.

1:30 PM

After lunch, I take the opportunity to review my emails and go through any ‘post’ cases – these are claims that have already been paid.  When we have capacity, we review these claims to ensure that they have been accurately paid, in case we need to go back and recover funds. 

2:00 PM

CEO Town Hall time!  Every quarter, the whole company is invited to join our CEO and the Executive team to connect, ask questions, and find out how the business is going.  It’s great to hear the Executive talk about the business.  It helps me feel included and I like that we get an overview of how GMHBA is tracking financially.  It’s important to me that the rest of the business gets the opportunity to hear about what my team does too -  it highlights our work and shows what an essential part of the business we are.  Today we also watched a fun “People Wrap” video that showcased what different staff are working on and what their highlights have been this quarter.

3:00 PM

Afternoon tea is provided after the Town Halls so I grab a pastry.  On other weeks, our team usually has a quick Chocolate break around this time to keep the energy levels up!

3:30 PM

Today I have my health check – GMHBA pays for free health checks for staff, we can have a basic health screen or a comprehensive assessment, and the exercise physiologist today provides me with some personalised guidance and support.  It’s a good way for me to stay healthy – but I’m also doing it to earn points for my AIA Vitality reward – I’m going for Platinum status which means I will get 50% off my next visit to the Endota Spa!   

4:30 PM

After an action packed day I log off and relax on the train ride home to Melbourne. If I’m working from home, I will usually wind down by going for a walk to soak up the last bit of daylight before it gets dark outside.

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