Junior Claims Analyst

Description

Job Summary: Junior Claims Analyst to analyze hospital medical bills, identify inconsistencies, and handle claim denials, ensuring accurate billing. Key Highlights: 1. Administrative, technical, and medical claim analysis and resolution. 2. Hospital account auditing and analysis using the MV system. 3. Proactive involvement to prevent billing inconsistencies. **Opportunity:** We are seeking a JUNIOR CLAIMS ANALYST to join our team at our headquarters in Barueri. **Responsibilities:** * Analyze hospital medical bills before and after billing to identify inconsistencies and potential claim denials. * Handle administrative, technical, and medical claim denials. * Prepare and follow up on claim appeals with health insurance operators. * Review electronic medical records and verify consistency between clinical documentation and billed items. * Ensure accurate billing for supplies, medications, fees, and procedures performed. * Validate supply and medication values according to SIMPRO and Brasíndice pricing tables. * Analyze consistency among physician prescriptions, clinical progress notes, and billed items. * Use the MV system for auditing, verification, and analysis of hospital accounts. * Proactively collaborate with clinical and administrative teams to prevent billing inconsistencies. * Monitor denial indicators and propose improvements to the billing process. * Verify contractual rules and pricing tables of health insurance operators. * Prepare managerial reports on performance, denials, and recovered amounts. **Requirements:** * Completed undergraduate degree. * Intermediate or advanced Excel skills. * Knowledge of: \- Medical coding tables (TUSS, CBHPM, AMB) \- Pricing tables: SIMPRO and Brasíndice \- Health insurance operator rules and contracts \- Hospital billing (inpatient, outpatient, and SADT) \- Hospital packages and daily rates \- ANS regulations. **Benefits:** * Individual health insurance plan (after probationary period). * Transportation allowance. * Meal allowance (R$210.00\). * Dental plan. * Childcare assistance. * Hazard pay (R$ 324.20\). The position is **on-site**, located at the headquarters of HOSPITALIS NUCLEO HOSPITALAR DE BARUERI LTDA in Barueri. Minimum Education Level: High School (Secondary Education)