Junior Nursing Auditor

Description

Job Summary: We are seeking a Junior Nursing Auditor to organize, evaluate, validate, and issue technical opinions in nursing audits, provide consulting services, and actively participate in both internal and external audits. Key Highlights: 1. Conducting medical billing audits and providing technical support to the audit team. 2. Preparing technical reports and monitoring 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 services and actively participating in both internal and external audit processes. Key Responsibilities: * Conduct medical billing audits (outpatient, clinical, and surgical admissions), verifying billing consistency, prior authorization, and rejecting inappropriate 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 claim 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 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 Healthcare Auditing, Hospital Management, or related fields; * Experience with hospital management systems and auditing platforms; * Proven experience in nursing auditing, especially in hospital and outpatient medical billing; Unimed Costa do Sol opportunities are also extended to Persons with Disabilities (PwD). Minimum Education Level: Bachelor's Degree * Wellhub * Employee Assistance Program (PAE) * Birthday Day Off * Education Allowance * Transportation Allowance * Health Insurance Plan * Meal/Voucher Allowance (Flexible)