Junior Nursing Auditor

Description

Job Summary: We are seeking a Junior Nursing Auditor to organize, evaluate, and validate Nursing Audit services, providing consulting support for both internal and external audits. Key Highlights: 1. Participation in medical billing audits and support to the audit team. 2. Preparation of technical reports and monitoring of medical productivity. 3. Nursing degree with active COREN registration and knowledge of ANS regulations. We are looking for a "Junior Nursing Auditor" to organize, evaluate, validate, and issue technical opinions regarding Nursing Audit services. This professional will also be responsible for providing consulting support and actively participating in both internal and external audit processes. Main Responsibilities: * Conduct medical billing audits (outpatient, clinical, and surgical admissions), verifying billing consistency, prior authorization, and rejecting improper charges; * Provide technical and administrative support to the Prospective Audit team, working collaboratively with physician auditors; * Update monthly reports related to audits of accredited network providers and cooperatives, including rejections and appeals; * Conduct on-site external audits at accredited network providers; * Prepare technical audit reports and monitor the medical productivity of accredited providers. Requirements: * Completed Nursing degree with active COREN registration; * Knowledge of ANS regulations and billing fee schedules (CBHPM, TUSS, etc.); * Strong communication skills, analytical mindset, and attention to detail; * Availability for external visits (on-site audits). Preferred Qualifications: * Postgraduate degree in Health Auditing, Hospital Management, or related fields; * Experience with hospital management systems and auditing platforms; * Proven experience in nursing auditing, particularly in hospital and outpatient medical billing; Opportunities at Unimed Costa do Sol are also extended to Persons with Disabilities (PWDs). Minimum Education Level: Bachelor's Degree * Wellhub * Employee Assistance Program (EAP) * Birthday Day Off * Education Allowance * Transportation Benefit * Health Insurance * Meal/Voucher Allowance (Flexible)