Browse
···
Log in / Register
Job Summary: A professional responsible for executing and monitoring accreditation, de-accreditation, and maintenance processes of the healthcare provider network, performing technical and administrative analyses. Key Highlights: 1. Strategic involvement in managing the healthcare provider network. 2. Leadership in guiding accreditation and negotiation processes. 3. Market and trend analysis in the supplementary health sector. * A professional responsible for executing and monitoring accreditation, de-accreditation, and maintenance processes of the healthcare provider network, in accordance with internal policies and regulatory requirements. Conducts technical and administrative feasibility and operational impact analyses to support contractual negotiation decisions, fee adjustments, and network optimization. **Responsibilities and Duties** * Analyze contracts, spreadsheets, and fee adjustment reports. * Prepare reports to support de-accreditation analyses by management. * Develop negotiation proposals and fee adjustment proposals for accredited providers. * Work with BI systems and present information to management. * Guide and supervise business analysts in identifying potential services for accreditation within the Operator's coverage areas and expansion areas defined by management. * Guide the analyst team in organizing schedules for periodic maintenance visits to the accredited network. * Conduct on-site visits and meetings for negotiation and contracting of new providers, in accordance with institutional guidelines. * Monitor and analyze trends and market movements in the supplementary health sector. **Requirements and Qualifications** * Prior experience in a Supplementary Health Operator, preferably in areas such as accredited network, accreditation, contracts, regulation, or medical billing. * Experience in managing accreditation, de-accreditation, and provider registration maintenance processes. * Experience analyzing healthcare coverage, installed capacity, and network adequacy per ANS regulations. * Participation in contractual negotiations, fee adjustments, and application of reimbursement fee schedules (CBHPM, AMB, TUSS, or similar). * Practical knowledge of supplementary health regulation, including ANS Normative Resolutions (RNs), the Procedures List (Rol), and clinical guidelines. * Experience interfacing with internal departments (Legal, Medical Billing, Finance, Regulation, and Auditing). * Proficiency in using network management systems, contract management systems, or medical-hospital billing systems, as well as analyzing operational and clinical reports. **Additional Information** **Benefits:** Transportation Allowance or Fuel Voucher Attendance Card Meal Voucher or Food Allowance Health and Dental Plan – employee exempt from monthly premium Annual bonus based on goal achievement GymPass – access to gyms and wellness programs Life Insurance **Working Hours:** 08:00–12:00, 13:00–17:48, Monday to Friday We are a strong, experienced group driven by health. The DC Group is a platform of independent brands and services united by a shared purpose: **providing health solutions for people.** **STRENGTH. HEALTH. KNOWLEDGE.** These three pillars guide our actions. It is from this foundation that our companies grow and increasingly distinguish themselves in their respective fields. With ethics, social commitment, and continuous evolution, we continue promoting quality of life, facilitating and simplifying access to healthcare, and innovating in the management of our processes and services. **We are the DC Group, and here, we breathe health.**
