CREDENTIALING ANALYST

Description

Working at MedSênior means feeling cared for. It means living the purpose of healthy aging, building an inspiring culture aligned with the values we believe in. We are a dynamic company, and our expansion offers constant opportunities for everyone. Together, we are Bem+. We operate in 8 states and have expansion plans—would you like to join us in this purpose? Learn more about open positions and apply. Our job openings are also valid for persons with disabilities (PCD). \#MedSênior \#jobopenings \#hiring \#opportunities \#technology \#health \#hiringnow **Important: We do not charge any fees during our selection processes.** **Responsibilities and duties** * Negotiate contractual correction indices as stipulated in agreements and/or determined by management for services provided by credentialed providers, to maintain contract updates. * Implement adjustments as requested by credentialed providers via email; draft contractual amendments including the respective correction indices. * Guide the Credentialing Assistant on reviewing documentation against the checklist for new external service providers—including credentialed providers—as well as internal service providers, performing necessary document updates to ensure current information is maintained. * Formalize contracts and amendments according to the ANS list regarding provider credentialing upon completion of negotiations, verifying adherence to terms agreed upon by senior management, thereby ensuring regulatory compliance and meeting corporate demand. * Monitor and/or negotiate contractual terms with service providers to complete and formalize credentialing and/or service delivery agreements through contracts or amendments. * Formalize received, processed, and ongoing requests via email to superiors for tracking, awareness, and support in resolving complex cases. * Conduct critical analysis of contracts and amendments received for new credentialing and contract updates, seeking input from department heads of interfacing areas (Medical Claims, DAC, Finance) and/or the Legal Department when necessary, to provide consistent feedback to providers. * Retrieve codes from the TUSS table and proprietary tables for Packages, Materials and Medications, Daily Rates, and Fees from the Provider Registration area’s published tables, for inclusion in credentialing contracts and amendments. **Requirements and qualifications** * Completed undergraduate degree in Business Administration or related fields; * Prior experience in health insurance operators, provider relationship management, credentialing, or healthcare network management; * Familiarity with ANS regulations and guidelines for supplementary health; * Proficiency in Microsoft Office Suite; * Experience with Sênior and Tasy systems is desirable. **Additional information** * Benefits: Meal voucher, Health and Dental Plans, Gympass, Birthday leave, Psychological support, and Transportation allowance. It means living the purpose of healthy aging, building an inspiring culture aligned with the values we believe in. We are a dynamic company, and our expansion offers constant opportunities for everyone. Together, we are Bem+. We are a market reference in elderly care, offering beneficiaries more than just a health plan—we deliver comprehensive, integrative assistance throughout the process of healthy aging. Founded to serve individuals aged 49+, our history is rooted in preventive medicine and innovation. Our purpose is to deliver the best possible care experience in support of healthy aging—humanely and with the compassion every beneficiary deserves.