Analyst at Unimed managing provider network compliance and performance indicators through operational oversight and institutional relationship maintenance in Brazil.
Responsibilities
Validate the application of the contractual index (IPCA) according to the conditions established in the contract, performing checks and making annotations when necessary.
Conduct periodic visits to providers, focusing on operational contract monitoring and institutional relationship management.
Support providers in communication with the head office, acting in situations with low resolvability to restore operational flow and the relationship.
Collect and analyze provider performance indicators, with a focus on billing, care profile and service delivery, preparing comparisons and management input.
Monitor network qualification according to criteria defined by the head office, ensuring adherence to mandatory regulations and internal guidelines.
Execute the documentation process for new credentialing, ensuring registration and regulatory compliance.
Perform systematic evaluation of new credentialing according to pre-established criteria.
Monitor the registration progress of new providers, ensuring information is up to date and consistent.
Verify the alignment of the new provider's profile with the conditions defined by the Interchange area, reporting deviations when identified.
Assist providers through multiple communication channels, logging and following up on requests according to defined workflows.
Requirements
Bachelor's degree in Administration, Healthcare Management or related fields
Previous experience in provider network management, credentialing, negotiation or related areas within supplementary healthcare
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