Network Management Analyst

Description

Job Summary: Analyst responsible for managing and updating providers and cooperatives, ensuring regulatory compliance and maintaining positive relationships with the accredited network. Key Highlights: 1. Network management and compliance with ANS regulations 2. Negotiation and fee adjustments with providers 3. Strengthening relationships and training the provider network **Job Description:** ---------------------- Analyze and oversee the processes of Provider and Cooperative Inclusion, Exclusion, and Update within the Management System, as well as receipt and verification of documentation related to these processes, ensuring accurate and up-to-date data entry and maintenance; Analyze and oversee administrative processes related to Accreditation activities (e.g., Inclusion, Exclusion, and Update of Service Providers and Cooperatives in the Management System; Configuration of eligible and ineligible services; Receipt and verification of documentation; Contract renewal; Updates to electronic medical billing forms; Updating accredited network data with ANS via PTA and other communication channels), monitoring process execution through sampling and supporting and training assistants whenever necessary. Analyze high-complexity requests received from the accredited network (cooperatives, providers) via e\-mail, telephone, and incident reporting tools, ensuring positive relationships and providing accurate responses to service providers; Analyze and oversee changes affecting the accredited network in response to ANS requirements, ensuring compliance with regulatory requirements; Analyze, structure, update, and implement payment and billing tables in the Management System whenever fee adjustments or renegotiations occur, ensuring correct payments and collections and avoiding financial losses; Conduct fee adjustment negotiations with the accredited network regarding Materials, Medications, Fees, Daily Rates, Medical Fees, SADT procedures, and Packages, based on prior analyses and impact studies, using consistent arguments while always preserving contracted services at sustainable rates; Implement initiatives to strengthen relationships with the Accredited Network through meetings (in-person or virtual), newsletters, and other communication channels; Conduct targeted training sessions for the accredited network to resolve operational questions and improve data quality submitted by providers to the Health Plan Operator; Proactively identify new service providers to expand and enhance the provider network; Analyze and oversee the monthly submission of mandatory Accredited Network information to Unimed do Brasil (e.g., Network Management Software, PTU A400 and PTU A450 files), ensuring compliance with Unimed do Brasil requirements; Support development of the Provider Network Qualification Program, conducted annually through technical visits, reviewing and implementing improvements to the Program whenever necessary; Support preparation of the annual Provider Network Qualification Program report for presentation to Management and the Board of Directors, highlighting the financial impact of provider category changes; Support activities performed by the Network Management team, providing technical/operational training whenever necessary. **Essential Requirements:** ------------------------------ Bachelor’s degree in Administration or related fields. Experience in the hospital sector Knowledge of ANS regulations **Employment Type:** -------------------------- CLT **PCD:** -------- NOT APPLICABLE **Salary:** ------------ $3,450\.71 **Benefits:** --------------- Meal/Voucher Allowance R$1487,87 Mobility Allowance Remote Work Allowance Birthday Day Off Health and Dental Insurance Life Insurance Study Grant Wellhub **Work Location:** ---------------------- Unimed Cerrado \- Aeroporto District **Working Hours:** ------------------------ Hybrid \- 08:00 to 17:00, Monday to Friday