Job Summary: Responsible for ensuring accurate calculation, auditing, and processing of payments for medical fees and healthcare teams, guaranteeing transparency and fairness in reimbursements. Key Highlights: 1. Ensure transparency and fairness in the disbursement of medical fees 2. Audit amounts and analyze medical billing statements 3. Maintain detailed records of remuneration contracts Responsible for ensuring the accurate calculation, auditing, and processing of payments to physicians and healthcare teams, in compliance with established contracts, current fee schedules, and internal institutional policies. This professional ensures transparency and fairness in reimbursements, directly contributing to clinical staff satisfaction and organizational financial sustainability through rigorous cost control and proper allocation of funds. **Responsibilities and Duties** * Calculate medical and multidisciplinary team fees individually based on procedures performed, service agreements, and commercially agreed terms with each physician or medical group. * Process reimbursements promptly, ensuring necessary organization and documentation for payments. * Audit amounts to be reimbursed by cross-checking service delivery information (from medical records, billing systems, and health insurers) against contractual remuneration rules. * Analyze and verify medical billing statements to ensure all billed and received items correspond to services generating entitlement to fees. * Maintain a detailed and up-to-date record of remuneration contracts with each physician and team, including percentages, fixed amounts, deduction rules, and any other relevant clauses. * Communicate\-with physicians and their secretaries to clarify questions regarding reimbursement calculations, adjustments, and contractual rules. * Collaborate in reviewing and updating medical remuneration contracts and agreements, ensuring compliance with market practices and legislation. * Investigate and resolve discrepancies in fee payments by analyzing physician complaints and providing justifications or implementing necessary adjustments. * Proactively identify common causes of discrepancies and propose process improvements to minimize them. * Generate periodic reports on reimbursement volume, distribution by specialty, and physician. * Provide strategic information to management regarding the performance of remuneration agreements and trends in medical fee costs. * Utilize hospital management systems (ERP), medical billing and reimbursement modules, electronic spreadsheets, and other tools for efficient registration, control, and processing of information. * Stay updated on ANS regulations, Federal Revenue rules, and any other legislation affecting healthcare professional remuneration. * Collaborate with billing, contracts, and cost teams to optimize data entry processes that directly impact reimbursement calculations. * Comply with internal regulations, quality management system requirements, observance and compliance with ANS regulations, as well as health, hygiene, and occupational safety standards inherent to the sector, including use of PPEs/collective protective equipment (EPIs/EPCs) where required by the activity. * Perform other duties inherent to the position or as directed by the immediate supervisor, provided the individual is qualified and such duties align with their knowledge and experience. **Requirements and Qualifications** Bachelor’s degree completed in Administration, Sciences, Accounting, Economics, or related fields. Proficiency in Excel and hospital ERP systems (TASY, MV, or similar). Knowledge of procedure classification tables (TUSS, CBHPM) and medical reimbursement rules. Familiarity with healthcare legislation (ANS) and contract management. **Additional Information** **What You’ll Get Here:** **Health and Well\-Being** * **Medical Assistance:** Outpatient, hospital, and obstetric coverage for you and your legal dependents. * **Dental Assistance:** Plans with company subsidies covering basic procedures, orthodontics, and prosthetics. * **Pharmacy Benefit:** Convenience for purchasing medications at accredited networks with payroll deductions and limits based on salary. * **Wellhub (Gympass):** Wellness platform offering access to gyms and health apps, extendable to up to 3 dependents. **Meals and Food** * **Meal Card:** Amount credited per business day worked for daily meals. * **Food Card:** Monthly free credit to assist with grocery purchases. **Protection and Future** * **Private Pension Plan:** Company-established plan supporting financial reserve formation and future income. * **Life Insurance:** Coverage for death and disability, ensuring financial protection for you and your family. * **PPR (Profit Sharing Program):** Annual reward based on achievement of the cooperative’s collective goals. * **Mobility and Commute** * **Transportation Voucher:** Available for commuting between residence and workplace under in-person or hybrid work arrangements. * **Parking:** Agreements with parking networks near company units. **Quality of Life and Partnerships** * **Day Off:** One additional day off granted after your birthday for personal use. * **Family Support:** Daycare or babysitter assistance for female employees with children up to 16 months old. * **Benefits Club:** Partnerships and discounts with educational institutions, language schools, and leisure options. We manage the national operations of Unimed-branded health plans. We market nationwide corporate medical assistance, delivering health and well-being to over 2 million lives. With a human-centered focus and care at our core, we continually seek ways to strengthen relationships with our employees, beneficiaries, clients, and partners—providing an ever-better experience for everyone. Unimed Nacional values and supports diversity. People with disabilities, and individuals of diverse races, ethnicities, religions, genders, gender identities, nationalities, sexual orientations, or ages are considered for all positions, as we believe in the importance of cooperation, sharing ideas, and distinct perspectives. Everyone is welcome. **\#SomosUnilover \#Unimed**
João Silva
Indeed · HR
João Silva
Indeed · HR
