Analista de Contas Médicas Jr - Gestão de Contas - Ibirapuera

AACD; São Paulo; Presencial; BRL 30.000 - 45.000; Tempo integral

Resumo da oferta

A leading company in healthcare services is seeking a detail-oriented professional to manage billing processes and reimbursements. The role involves verifying authorizations, generating invoices, and ensuring compliance with contracts. Ideal candidates should have a degree in Business Administration or related fields and possess knowledge of relevant medical billing tables and systems. The company offers a range of benefits including medical assistance, transportation vouchers, and educational partnerships.

Serviços

Medical Assistance

Dental Assistance

Transportation Voucher

Life Insurance

On-site Cafeteria

Childcare Assistance

Breakfast

Medical Outpatient Service

Wellhub

Birthday Day Off

Natal Gift Basket or Voucher

Well-being Initiatives

We + Health Program

Payroll Loan

Seniority Rewards

Educational Partnerships

AACD Club

Pharmacy Partnerships

Qualificações

• Must be pursuing or have completed a degree in Business Administration or related fields.
• Knowledge in AMB Tables, CIEFAS, SIMPRO, BRASÍNDICE, TUSS, and SIGTAP is required.

Responsabilidades

• Verify/Validate authorizations, invoices, medical fees, and procedures.
• Generate electronic/XML files and send them to health operators.
• Analyze medical reimbursements to ensure HM payments are made.

Conhecimentos

Knowledge in AMB Tables

Knowledge in CIEFAS

Knowledge in SIMPRO

Knowledge in BRASÍNDICE

Knowledge in TUSS

Knowledge in SIGTAP

Basic knowledge of Office Suite

Formação académica

Degree in Business Administration

Related fields

Descrição da oferta de emprego

Job description

Analyzing all relevant documentation related to hospital medical service accounts to facilitate billing processes.

Main responsibilities

1. Verify/Validate authorizations, invoices, medical fees, daily rates, taxes, hemotherapies, procedures, SADTs, packages, exams, meals, special materials (OPME);
2. Enter corrections of accounts analyzed by Medical Audit into the system;
3. Inform relevant departments about missing authorizations and/or necessary documentation for billing;
4. Monitor released accounts through pending account reports to verify account status;
5. Begin account analysis using digital medical records;
6. Support related departments regarding billing issues such as dispute resources, finance, accounting, authorization center, OPME, and inpatient units;
7. Cross-check all information contained in the patient's records;
8. Generate electronic/XML files and send them to health operators and/or insurance providers;
9. Create invoices;
10. Assist in preparing, digitizing, copying, and sending accounts to health operators and/or insurance providers, ensuring signed protocols are returned via transportation when necessary;
11. Ensure billing is sent with appropriate information according to contracts and delivery schedules agreed with operators/insurers;
12. Analyze SUS accounts, SIGTAP table, SUS billing, and send XML/GRD files to the municipal health department;
13. Interact with all involved areas to gather necessary information and documents for account preparation and disseminate best practices to prevent future disputes.

Additional responsibilities

1. Generate Reimbursements;
2. Analyze medical reimbursements to ensure HM payments are made according to contract;
3. Create provisions for accounting;
4. Reconcile reimbursements with accounting;
5. Manage medical reimbursements, fixed payments, CDI payments, external provider payments, on-call payments, FUMCAD payments, variable remuneration, and medical scoring programs;
6. Handle reimbursement processes between the hospital and the operator;
7. Verify pending payments;
8. Register suppliers in the system;
9. Deduct disputes;
10. Mediate negotiations between the hospital and the insurer for collection of supplementary HMs;
11. Register and maintain reimbursement rules in the system;
12. Provide internal and external customer service;
13. Send payment statements to doctors and/or secretaries;
14. Receive invoices and enter them into the system;
15. Collect authorizations/signatures for payment.

Requirements and skills

• Must be pursuing or have completed a degree in Business Administration or related fields;
• Knowledge in AMB Tables, CIEFAS, SIMPRO, BRASÍNDICE, TUSS, and SIGTAP is required;
• Basic knowledge of the Office Suite is desirable.

Additional information

What benefits do we offer our employees?

• Medical Assistance
• Dental Assistance
• Transportation Voucher
• Life Insurance
• On-site Cafeteria
• Childcare Assistance*
• Breakfast
• Medical Outpatient Service
• Wellhub
• Birthday Day Off
• Natal Gift Basket or Voucher
• Well-being Initiatives
• We + Health Program
• Payroll Loan
• Seniority Rewards
• Educational Partnerships
• AACD Club
• Pharmacy Partnerships

*For women with children as per collective agreement.