Authorization and Care Guarantee Assistant

Description

Job Summary: Professional responsible for beneficiary support via chat/phone, analysis and forwarding of authorization forms, monitoring of high-cost medications and IUDs, reimbursement analysis, and identification of provider network members — ensuring compliance with ANS regulations. Key Highlights: 1. Direct customer service and support for beneficiaries across various requests 2. Analysis and monitoring of processes in accordance with ANS regulations 3. Management and coordination of medication and material requests and deliveries **Job Description:** ---------------------- Perform daily beneficiary support via chat or phone for authorization requests, providing the case protocol throughout the interaction to ensure adherence to ANS-mandated deadlines; Perform daily authorization system operations, analyzing and forwarding beneficiary authorization forms from Unimed Cerrado via interexchange, preparing documents requested by the medical auditor and uploading them into the system, forwarding authorization forms requested by assistance funds to companies, receiving feedback, and finalizing entries in the system — all to ensure compliance with ANS deadlines and provide timely feedback to beneficiaries; Request and monitor procurement and availability of high-cost medications as needed, tracking delivery timelines and locations, managing subsequent delivery schedules (if applicable), recording information in the control spreadsheet for managerial oversight — thereby ensuring medication availability to beneficiaries per medical prescription and Unimed Cerrado medical audit validation; Request IUD procurement as needed, monitoring delivery timelines and locations, verifying insertion consent forms, and entering data into the control spreadsheet — to enable managerial tracking and ensure timely delivery to beneficiaries per medical prescription and medical audit requirements; Analyze reimbursement requests as received, conducting necessary investigations to support management decision-making and ensure deadline compliance; Identify provider network members as needed, reviewing requests received through various cooperative channels, facilitating required care as prescribed by attending physicians, and ensuring compliance with ANS-mandated deadlines; Conduct weekly ICU patient monitoring via spreadsheet, updating clinical status and number of hospitalization days to maintain accurate departmental data and information; Routinely track CRM-originated requests, manage case protocols, and respond within RN 566 Care Guarantee deadlines; Support handling of NIP (Preliminary Injunction Notice) and injunction cases by gathering necessary information for immediate resolution — ensuring timely care delivery to beneficiaries. **Mandatory Requirements:** ------------------------------ Completed High School Education Experience in procedure authorization and ANS legislation Microsoft Office Suite **Employment Type:** -------------------------- CLT **PCD (Persons with Disabilities):** -------- NOT APPLICABLE **Salary:** ------------ $1,927.13 **Benefits:** --------------- Meal/Voucher Allowance: R$1.487,87 Mobility Allowance (Public Transport, Uber, or Fuel): R$ 162.50 Annual PPR (Profit-Sharing Program) Birthday Day Off Life Insurance Wellhub/Gympass Health Insurance Plan Dental Insurance Plan Childcare Assistance Educational Scholarship **Work Location:** ---------------------- Unimed Cerrado — Aeroporto District **Working Hours:** ------------------------ Hybrid — Monday to Friday, 08:00 to 17:00