Appeals Analyst for Claim Denials

Description

Job Summary: Hospital Casa de Portugal is seeking a Billing Specialist to analyze and prepare claim denial appeals, contributing to financial efficiency and continuous improvement. Key Highlights: 1. Performing technical analysis of denied amounts and preparing appeals. 2. Opportunity to identify denial trends and support continuous improvement. 3. Collaborating with various departments to optimize internal processes. Hospital Casa de Portugal is looking for a Billing Specialist to join its Claim Denial Appeals team! If you have experience in hospital billing, enjoy technical analysis, and wish to work in an environment that values accuracy and financial efficiency, this position is for you. **Your responsibilities will include:** * Conducting detailed analysis of amounts denied by health insurers, identifying technical and administrative inconsistencies * Preparing claim denial appeals based on current contracts, clinical guidelines, and reference fee schedules (CBHPM, AMB, SIMPRO, and BRASÍNDICE) * Analyzing and preparing rebuttals when prior appeals are upheld by health insurers, reinforcing technical arguments * Managing and organizing all physical and digital documentation related to denied payments, ensuring traceability and data integrity * Tracking pending appeals and insurer responses, keeping records and systems up to date * Alerting the team and managers to potential internal process adjustments causing recurring denials * Contributing to identification of denial trends and supporting preventive actions and continuous improvement initiatives * Maintaining regular communication with departments such as Billing, Medical Claims, Registration, and IT **What we require:** * Completed high school education * **Minimum of 6 months of experience in this role** * Intermediate/advanced Excel proficiency (mandatory) * Microsoft Office suite (preferred) * Knowledge of hospital billing and medical claims analysis * Proficiency in healthcare fee schedules (CBHPM, AMB, SIMPRO, BRASÍNDICE) **Preferred qualifications:** * Familiarity with TUSS, CBHPM, and AMB * Experience with systems such as Zero Glosa, MV Soul, MV 2000, MC PEPTASY, ASA, Visual ASA, SPDATA, Cockpit, PMCL, or BIOSLAB **Desired profile:** organization, strong time management, effective communication, teamwork, and proactivity. Compensation: R$2\.611,45 per month Benefits: * Medical insurance * Dental insurance * Commercial partnerships and discounts * Commuter allowance Work location: On-site