Auditor at Exco engaging in financial audits for local and international clients. Working with a supportive team to enhance skills and methodologies in a structured environment.
About the role
- Auditor ensuring compliance in nursing procedures and hospital billing for Unimed. Analyzing documentation and managing the auditing process to meet legal standards.
Responsibilities
- Conduct audits of nursing procedures, outpatient services (SADT) and hospital billing.
- Verify the eligibility and appropriateness of claim/authorization forms by cross-checking information against supporting documentation.
- Apply denials to procedures, services and items that are inappropriate or non-compliant with regulations and cost guidelines.
- Analyze forms, check requests and enter relevant technical information into the SAW system for subsequent review and decision (authorization and/or denial) by the Medical Auditor.
- Ensure ongoing compliance of records and procedures with legislation, standards and internal policies.
- Support the analysis and systemic implementation of business rules and directives from regulatory sources such as ANS, Unimed do Brasil and Commercial Areas, impacting authorization, payment and billing of CNU providers.
- Check requests and manage authorization timeframes in accordance with ANS rules.
- Develop studies, compile information and present indicators (management reports and financial analyses) to support surgical authorization management and decision-making.
- Monitor the inflow and outflow of items being quoted, inspecting and advising the areas involved.
Requirements
- Required: Bachelor's degree in Nursing with active COREN (Regional Nursing Council) registration
- Preferred: Knowledge of the Intercâmbio module in the Unimed system and experience with retrospective accounts
Benefits
- Position open to candidates with disabilities (PcD)
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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