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Credentialing Analyst
Negotiable Salary
Indeed
Full-time
Onsite
No experience limit
No degree limit
R. Maria Bregua, 37 - São Lourenço, Niterói - RJ, 24120-007, Brazil
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Description

Description: * Completed higher education in Administration, Nursing, Economics, Health Management, or related fields. * Proven experience in credentialing or network management for health plan operators. * Proficiency in AMB, CBHPM, SIMPRO, BRASÍNDICE, and related fee tables. * Knowledge in medical bill analysis and interpretation of TISS forms. * Intermediate Office Suite skills, especially Excel and PowerPoint. * Experience with workflow systems, CRM, or contract management platforms. * Strong negotiation and argumentation abilities. * Interpersonal skills and a collaborative attitude. * Organized, detail-oriented, and capable of prioritizing tasks. * Clear and assertive communication. * Analytical mindset with focus on results. * Ability to work under deadlines and handle simultaneous demands. * Conduct negotiations with healthcare providers (clinics, laboratories, hospitals, doctors, and cooperatives), aligning technical and financial aspects with the operator's guidelines. * Interpret and apply negotiation and reference tables (AMB, CBHPM, SIMPRO, BRASÍNDICE, among others). * Prepare and review commercial proposals and contract amendments, ensuring coherence and financial sustainability. * Analyze medical bills, identifying cost optimization opportunities and charge standardization. * Produce and present managerial reports and performance indicators for the accredited network, using Office Suite tools (Excel, PowerPoint, Word) and internal systems. * Update and monitor workflow and contract management systems, ensuring compliance with deadlines and traceability of actions. * Maintain positive relationships with providers, acting ethically and collaboratively to strengthen strategic partnerships. * Support processes related to provider network credentialing and decertification. * Collaborate with Audit, Medical Billing, and Regulation departments to promote integration and operational efficiency. 2510120202241805394

Source:  indeed View original post
João Silva
Indeed · HR

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