Medical Account Analyst, Junior

Role Overview

• Analyze hospital medical accounts, disputes, denial appeals submitted by providers, reimbursements submitted by beneficiaries and the Unimed System, and arrange corresponding payments, releasing the payment process to the finance department, working under guidance;
• Verify that accounts meet regulatory requirements and comply with company rules by performing system checklists and review analyses, checking and validating amounts against fee schedules/references, and taking corrective actions when necessary;
• Monitor and propose changes, solutions and/or adjustments to workflows, rules in the MIN (Manual de Intercâmbio), ANS – National Supplementary Health Agency, and client portfolio invoices to improve daily processes;
• Maintain records of deliberations/assessments of processes, correctly enter justifications for decisions, check collection deadlines and ensure that signatures are present on deliberations generated by other departments;
• Enter and analyze provider service data and information in the system, notify any contractual modifications or system changes that enable the billing analysis to be closed accurately, and ensure payments are processed;
• Receive, spreadsheet and file medical service invoices, generate analytical reports, and analyze denial appeals and medical accounts;
• Review requests for billing and/or rebilling outside established deadlines according to company guidelines and responsibilities regarding acceptance and payment criteria for Unimeds, providers and companies;
• Review and release the configured edit checks/pre-analysis workflows (malhas) in the management system specific to your profile, and provide support to credentialed providers regarding account/appeal processes and other related issues as needed.

Requirements

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

Benefits

• Health Insurance: Outpatient, hospital and obstetrics coverage for you and your legal dependents.
• Dental Care: Company-subsidized plans covering basic procedures through orthodontics and prosthetics.
• Pharmacy Program: Convenience for purchasing medications at affiliated pharmacies with payroll deduction and limits based on salary.
• Wellhub (Gympass): Wellness platform providing access to gyms and health apps, extendable to up to 3 dependents.
• Meal Card: Amount credited per working day to cover daily meals.
• Grocery/Food Allowance Card: Monthly credit to assist with grocery purchases.
• Private Pension: Company-sponsored plan to help build financial reserves and future income.
• Life Insurance: Coverage for death and disability, providing financial protection for you and your family.
• PPR (Profit Sharing Program): Annual reward based on achieving the cooperative's collective goals.
• 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 prefer.
• Family Support: Childcare or nanny assistance for employees with children up to 16 months.
• Benefits Club: Partnerships and discounts with educational institutions, language schools and leisure options.