Medical Reimbursement Analyst, Mid-level

Role Overview

• Calculate individual physician and multidisciplinary team fees based on performed procedures, service contracts and the commercial terms agreed with each professional or medical group.
• Process reimbursements in a timely manner, ensuring the necessary organization and documentation for payments.
• Audit amounts to be reimbursed by cross-checking information about services provided (from medical records, the billing system and payers) against contractual remuneration rules.
• Review and reconcile medical account statements (billing statements) to ensure all billed and received items correspond to services that generate fee entitlement.
• Maintain a detailed, up-to-date record of remuneration contracts with each physician and team, including percentages, fixed amounts, deduction rules and any other relevant clauses.
• Communicate with physicians and their administrative assistants to clarify doubts about reimbursement calculations, adjustments and contractual rules.
• Collaborate in the review and update of physician remuneration contracts and agreements, ensuring compliance with market practices and applicable legislation.
• Investigate and resolve discrepancies in fee payments by analyzing physicians' claims and providing justifications or making the necessary adjustments.
• Proactively identify common causes of discrepancies and propose process improvements to minimize them.
• Generate periodic reports on reimbursement volumes, distribution by specialty and by physician.
• Provide strategic information to management on the performance of remuneration agreements and trends in physician fee costs.
• Use hospital management systems (ERP), medical accounts and reimbursement modules, spreadsheets and other tools for efficient recording, control and processing of information.
• Stay up to date on ANS regulations, Federal Revenue requirements and any other legislation that affects health professional remuneration.
• Collaborate with billing, contracts and cost teams to optimize data-entry processes that directly impact reimbursement calculations.
• Comply with internal regulations, quality management system requirements, observe ANS regulations as well as applicable health, hygiene and occupational safety norms; use PPE/CPE (Personal Protective Equipment / Collective Protective Equipment) when the activity requires it.
• Perform other duties inherent to the position or as directed by your immediate supervisor, provided you are qualified and the tasks align with your knowledge and experience.

Requirements

• Bachelor's degree in Administration, Accounting, Economics or a related field.
• Proficiency in Excel and hospital ERP systems (TASY, MV or similar).
• Knowledge of procedure tables (TUSS, CBHPM) and physician reimbursement rules.
• Familiarity with health sector legislation (ANS) and contract management.

Tech Stack

• ERP

Benefits

• Medical Insurance: Outpatient, hospital and obstetric coverage for you and your legal dependents.
• Dental Insurance: Company-subsidized plans covering basic treatments through orthodontics and prosthetics.
• Pharmacy Agreement: Access to medication purchases at accredited pharmacies with payroll discount and a limit based on salary.
• Wellhub (Gympass): Wellness platform with access to gyms and health apps, extendable to up to 3 dependents.
• Meal Card: Daily amount credited for working days to cover daily meals.
• Grocery Card: Monthly credit to assist with grocery purchases.
• Private Pension: Company-established plan to help build financial reserves and future income.
• Life Insurance: Coverage for death and disability to provide financial protection for you and your family.
• PPR (Profit Sharing Program): Annual reward based on achievement of the cooperative's collective goals.
• Transportation Voucher: Available for commuting between home and work in on-site or hybrid work arrangements.
• Parking: Agreements with parking facilities near company sites.
• Day Off: One day off granted after your birthday for you to use as you prefer.
• Family Support: Childcare or nanny assistance for female employees with children up to 16 months.
• Benefits Club: Partnerships and discounts with educational institutions, language schools and leisure options.