Accredited Network Management Analyst

Description

Job Summary: Analyzes and manages processes for the inclusion, exclusion, and updating of providers and cooperatives, ensuring regulatory compliance and maintaining relationships with the accredited network. Key Highlights: 1. Strategic management of accreditation and network relationship 2. Analysis and implementation of payment and billing tables 3. Development and qualification of the provider network **Job Description:** ---------------------- Analyze and be responsible for the process of including, excluding, and updating providers and cooperatives in the Management System, as well as receiving and verifying documentation related to these processes, ensuring accurate and up-to-date data entry and maintenance; Analyze and be responsible for administrative processes related to accreditation activities (e.g., inclusion, exclusion, and updating of service providers and cooperatives in the Management System; configuration of services eligible or ineligible for execution; receipt and verification of documentation; contract renewal; updating of electronic medical fee schedules; updating of accredited network data with ANS via PTA and other communication channels), monitoring process execution through sampling and supporting and training assistants whenever necessary. Analyze high-complexity requests received from the accredited network (cooperatives, providers) via email, phone, and incident reporting tools, ensuring sound relationships and accurate responses to service providers; Analyze and oversee changes affecting the accredited network in response to ANS requirements, ensuring compliance with regulatory requirements; Analyze, structure, update, and implement payment and billing tables in the Management System whenever adjustments or renegotiations of values occur, ensuring correct payments and collections and avoiding financial losses; Negotiate adjustments with the accredited network regarding materials, medications, fees, daily rates, medical fees, SADT procedures, and packages, based on prior analyses and impact studies, using consistent arguments while always preserving contracted services at sustainable rates; Develop initiatives to strengthen relationships with the Accredited Network through meetings (in-person or virtual), bulletins, and other communication channels; Conduct targeted training for the accredited network to resolve operational questions and improve the quality of data submitted by providers to the Operator; Proactively seek new service providers to expand and qualify the Provider Network; Analyze and be responsible for the monthly submission of mandatory Accredited Network information to Unimed do Brasil (Network Management Software, PTU A400 and PTU A450 files, etc.), ensuring compliance with Unimed do Brasil requirements; Support the development of the Provider Network Qualification Program, implemented annually through technical visits, reviewing and applying improvements to the Program whenever necessary; Support the preparation of the annual Provider Network Qualification Program report to present to Management and the Board the financial impact of provider category changes; Support activities performed by the Network Management team, providing technical/operational training whenever necessary. **Essential Requirements:** ------------------------------ Completed undergraduate degree in Business Administration or related fields. Experience in the hospital sector Knowledge of ANS regulations **Employment Type:** -------------------------- CLT **PwD (Persons with Disabilities):** -------- NOT APPLICABLE **Salary:** ------------ $3,450\.71 **Benefits:** --------------- Meal/Voucher Allowance R$1487,87 Mobility Allowance Remote Work Allowance Birthday Day Off Health and Dental Insurance Life Insurance Scholarship Program Wellhub **Work Location:** ---------------------- Unimed Cerrado \- Aeroporto District **Working Hours:** ------------------------ Hybrid \- 08:00 to 17:00, Monday to Friday