Nurse Auditor

Description

Job Summary: Conducts technical and administrative analysis of hospital bills and medical records to ensure compliance, optimize resources, and guarantee the quality of healthcare processes. Key Highlights: 1. Technical audit of hospital bills 2. Preparation of technical opinions and reports 3. Negotiation and mediation of claim denials Performs technical and administrative analysis of hospital bills and medical records, verifying consistency between billed items and services rendered. Ensures technical compliance, identifies claim denials, and optimizes resource utilization to guarantee quality and sustainability of healthcare processes. * Technical audit of hospital bills (prior, concurrent, or retrospective). * Beneficiary visit: Updating clinical status and managing pending issues; * Beneficiary visit: Assessing appropriateness of accommodation and proposing discharge planning. * LP meetings: Participating in meetings with health insurers to discuss long-stay hospitalized patients; * Adverse events: Identifying and reporting locally identified adverse events; * Collaborating closely with other professionals; * Analysis of extensions: Medical audit of hospital daily rates requested by providers to insurers; * Identifying opportunities to improve work productivity and efficiency; * Staying updated on regulations and guidelines related to fee schedules; * Early identification of potential rule/application errors in bills requiring correction; * Organizing time to deliver requested work aiming at results. * Medical record review, verification of medications, supplies, and fees. * Preparation of technical opinions and reports on non-conformities. * Negotiation and mediation of claim denials with providers and insurers. * Monitoring of quality and hospital care indicators.