Medical Accounts Analyst, Junior

Role Overview

• Analyze hospital medical claims, disputes, and denial appeals submitted by Providers, reimbursements submitted by beneficiaries and the Unimed System, and arrange the corresponding payments, releasing the payment process to the finance department while working under guidance.
• Verify that claims comply with regulatory requirements and company rules, performing checklists through the system and analyses, checking and validating amounts against established tables/references, and making adjustments when necessary.
• Monitor and propose changes, solutions and/or adjustments to workflows, MIN (Interchange Manual) rules, ANS (National Supplementary Health Agency) regulations, and client portfolio invoices to improve daily processes.
• Maintain records of process deliberations/assessments, correctly enter justifications for decision-making, and verify collection deadlines and the presence of signatures on deliberations generated by other areas.
• Enter and analyze provider service data and information in the system, notify any contractual modifications or system changes that affect closure of bill analysis, in order to ensure and arrange payments.
• Receive, record in spreadsheets, and file invoices for medical service providers; generate analytical reports; and perform analysis of denial appeals and medical claims.
• Analyze requests for billing and/or re-billing submitted after deadlines, in accordance with company guidelines and responsibilities regarding acceptance and payment criteria for Unimeds, Providers and companies.
• Review and release edits (pre-analysis of medical claims in the management system) assigned to your profile, and provide support to Accredited providers regarding Claims/Appeals processes and other matters when necessary.

Requirements

• Bachelor's degree in Business Administration, Accounting, Economics, or a related field.
• Experience in the area.
• Proficiency in Excel.

Benefits

• Medical Coverage: Outpatient, hospital and obstetric coverage for you and your legal dependents.
• Dental Coverage: Company-subsidized plans covering procedures from basic care to orthodontics and prosthetics.
• Pharmacy Benefit: Access to discounted medications at partner pharmacies with payroll deduction and a salary-based limit.
• Wellhub (Gympass): Wellness platform providing access to gyms and health apps, extendable to up to 3 dependents.
• Meal Card: Amount credited per worked business day 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, ensuring financial protection for you and your family.
• PPR (Profit Sharing Program): Annual reward based on achieving the cooperative's collective targets.
• Transportation Voucher: Available for commuting between home and work in on-site or hybrid arrangements.
• Parking: Agreements with parking networks near company locations.
• Day Off: One day off granted after your birthday for you to use as you wish.
• Family Support: Daycare or nanny assistance for employees with children up to 16 months old.
• Benefits Club: Partnerships and discounts with educational institutions, language schools and leisure providers.