Billing Analyst

Description

Job Summary: A professional to analyze and audit medical and hospital bills, ensuring compliance with applicable tables and standards, and participating in technical and administrative claim denial processes. Key Highlights: 1. Analyze and audit medical and hospital bills received from providers 2. Ensure bill compliance with TISS and TUSS standards 3. Participate in technical and administrative claim denial processes **Description and Responsibilities:** **Working Hours:** 08:00 to 18:00 **Level:** Operational **Employment Type:** Tenured \- CLT labor code * Analyze and audit medical and hospital bills received from providers, focusing on hospitalizations, surgeries, OPME, and outpatient services. * Verify correct application of CBHPM, Simpro, and Brasíndice fee schedules in submitted charges. * Validate billing for hospital fees, daily rates, materials, medications, and physician fees according to established contracts. * Ensure bill compliance with TISS and TUSS standards, identifying technical or administrative discrepancies. * Detect and record inconsistencies, non-conformities, or improper charges, applying technical and contractual criteria. * Participate in technical and administrative claim denial processes, documenting justifications and supporting rationale for each case. **Requirements:** * Proven experience in medical and hospital bill analysis and auditing. * Advanced knowledge of hospitalizations, surgeries, OPME, and hospital fees. * Proficiency in CBHPM, Simpro, Brasíndice, and TUSS fee schedules. * Familiarity with TISS and TUSS standards. * Ability to identify inconsistencies, improper charges, and technical/administrative claim denials. **Benefits:** Meal allowance, Medical assistance, Dental assistance, Gym allowance, Fuel allowance, Education allowance, Internal benefits, Parking, Life insurance, Meal voucher, Transportation voucher