Job Summary: Professional responsible for managing the full revenue recovery cycle, from analyzing payer denials to final payment receipt, with a focus on technical appeals of claim denials. Key Highlights: 1. Manage the full revenue recovery cycle 2. Technical appeal of claim denials for ambulance services 3. Prior experience handling claim denial appeals is desirable The professional will be responsible for managing the full revenue recovery cycle, from the initial analysis of payer denials to the actual receipt of payment. The primary focus is on technical appeals of claim denials for ambulance services (Basic Transport, Mobile ICU, and Events). Main Responsibilities: Denial Analysis: Identify reasons for claim denials applied by health insurers on transport services. End-to-End Appeals: Prepare and submit administrative appeals via payer portals (TISS/TUSS). Internal Audit: Verify service reports, material checklists, and mileage spreadsheets ($Km$ driven) to ensure contractual compliance. Fee Schedule Management: Accurately apply fee schedules versus codes (proprietary schedules). Financial Reconciliation: Process payment postings and track claim recovery targets. Payer Relationship Management: Maintain direct contact with payers to resolve registration or technical issues. Desired Profile Experience: Prior experience handling claim denial appeals, preferably in ambulance companies. Technical Knowledge: Proficiency in TISS standards and reference fee schedules. Skills: Intermediate Excel (for tracking transportation cost spreadsheets) and critical thinking regarding administrative processes. Advantage: Knowledge of billing rules for waiting time fees, physician accompaniment, and advanced life support materials. Employment Type: Full-time CLT Compensation: R$1\.900,00 \- R$2\.400,00 per month Benefits: * Meal Allowance * Transportation Allowance Selection Question(s): * Please state your most recent salary Experience: * 6 months in this role? (Mandatory) Work Location: On-site
João Silva
Indeed · HR
João Silva
Indeed · HR
