Job Summary: The professional will manage medical billing verification and audit processes, coordinate hospital and outpatient billing, and lead the corporate medical billing team. Key Highlights: 1. Manage medical billing verification and audit processes 2. Coordinate hospital and outpatient billing 3. Lead the corporate medical billing team You are applying to our talent pool for positions across Brazil, in locations where Rede Américas operates (Northeast, Central-West, Southeast, and South regions of Brazil). Therefore, please note that as soon as a vacancy matching your profile becomes available, we will contact you. In the meantime, please keep your information updated and complete all online assessment stages so we can learn more about you. ***Important: We do not charge any fees during our selection processes.*** **Responsibilities and Duties** Here, your role makes a difference every day. Check the details about this position: * Manage medical billing verification and audit processes, defining guidelines, monitoring execution, and ensuring standardization across units, with the objective of ensuring compliance with contracts, fee schedules, and regulatory standards. * Coordinate hospital and outpatient billing at the corporate level, monitoring deadlines, validating information, and aligning with operational areas to ensure accurate and timely invoice issuance. * Establish and monitor departmental performance indicators, analyzing data, identifying deviations, and proposing corrective actions to promote efficiency, control, and continuous improvement. * Lead the corporate medical billing team, distributing responsibilities, promoting training, and monitoring results to maintain a technically skilled, engaged team aligned with institutional guidelines. * Interact with health insurance providers and internal departments, negotiating claim denials, clarifying questions, and aligning processes to ensure smooth communication and reduce financial losses. * Ensure correct application of billing fee schedules (TUSS, CBHPM, AMB, etc.), updating systems, guiding teams, and auditing entries to prevent inconsistencies and financial losses. * Support the implementation of improvements in hospital management systems, testing functionalities, suggesting adjustments, and monitoring outcomes to optimize medical billing processes. * Prepare managerial reports and strategic analyses, compiling data, evaluating trends, and supporting leadership to aid decision-making and organizational financial management. * Ensure compliance with ANS regulations and other applicable legislation, monitoring regulatory updates and implementing process adjustments to guarantee compliance and avoid penalties. * Represent the medical billing department in internal and external forums, participating in meetings, committees, and industry events to strengthen institutional performance and promote best practices. **Requirements and Qualifications** If you believe that **care** begins with preparation and intention, this may be the right place for you. To **care** with us, it is important to have: * Completed undergraduate degree. * Postgraduate degree in Health Auditing, Health Management, or related fields. * Solid experience in medical billing management and hospital billing. * Proficiency in TUSS, CBHPM, and AMB fee schedules. * Experience in denial analysis and appeals. * Experience in developing and monitoring performance indicators and managerial reports. * Experience with hospital management systems (e.g., Tasy, MV, SoulMV). **Additional Information** Our **care** starts at home, delivering the best for our people. At Rede Américas, we value those who build **care** daily. Therefore, we offer benefits designed for your well-being, development, and quality of life. Check them out: * **Care** for nutrition: meal allowance, food voucher, or on-site cafeteria (depending on the unit); * **Care** for health: health insurance and life insurance; * **Care** for your development: Américas Academy, Development and Career Cycle, Culture Academy, and the “Crescer” Program within Rede Américas; * Others: transportation allowance, SESC benefits, and recognition programs. Only at Rede Américas do we offer the “Bem Cuidar” Program, grounded in the pillars of physical, mental, and emotional health. Our care initiatives are thoughtfully designed for our people’s well-being, promoting healthy habits, preventing diseases, and contributing to stress reduction. Learn more: * Mental and emotional health: specialized psychosocial support and counseling provided by psychologists, psychiatrists, and social workers, tailored to each individual’s care needs; * Social assistance: remote social support provided by social workers for issues such as financial insecurity, health concerns, guidance on social benefits, and others; * For pregnant employees: multidisciplinary follow-up and monthly discussion groups; * Quality of life: with TotalPass, you gain access to gyms and physical activities under special conditions—more health and well-being for your daily life; * Health campaigns: monthly awareness initiatives based on health management data, focused on prevention and promotion of healthy habits. * Social benefits: our internal policies provide additional support and well-being for those who need it—including persons with disabilities, individuals with Autism Spectrum Disorder (ASD), oncology patients, and pregnant employees. * Benefits may vary depending on the job location and brand. If care is also your passion, this is your place. Apply now and build a career that connects purpose and practice. We are Rede Américas, **a multiplatform healthcare assistance network**, whose purpose is to deliver comprehensive, precisely tailored healthcare. We are seeking **talents who believe it is possible to provide the best and most advanced healthcare assistance.** **If you are passionate about caring and believe in high-quality medicine, join Rede Américas!** **We Are Committed to Diversity!** We encourage applications from all individuals who recognize the importance of building an environment free of prejudice, harassment, and discrimination. Together, we always deliver our best. **Important: We do not charge any fees during our selection processes.**
João Silva
Indeed · HR
João Silva
Indeed · HR
