Medical Auditor – Retrospective

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Grupo Fácil

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1996

💸 Finance

💳 Fintech

Healthcare • Finance • Fintech

Grupo Fácil is a national reference in technology and solutions for the Healthcare and Financial institutions sectors, with over 29 years of experience. The group is composed of several companies that excel in customer service and technical excellence, focusing on delivering surprising results and being closely connected to market trends. Grupo Fácil prides itself on its solidity and boldness in undertaking projects that set a benchmark in the industry.

📋 Description

• Retrospective Medical Claims Audit: Perform technical analysis and auditing of medical-hospital accounts, ensuring compliance between the care provided, billed items, medical protocols and contracted agreements. • Regulatory Management and ANS: Prepare medical opinions and technical responses to Preliminary Intermediation Notifications (NIP) and correspondence directed to the National Supplementary Health Agency (ANS). • Defenses and Appeals: Prepare technical responses and defenses to Notices of Infraction addressed to the ANS, working in coordination with the legal and regulatory departments. • Continuous Improvement: Identify clinical/operational deviations and propose corrective measures to ensure faithful compliance with established standards for the provision of medical care in the supplementary health sector.

🎯 Requirements

• Education: Medical degree (complete) with active and regular registration with the Regional Medical Council (CRM). • CNPJ: Be part of the shareholder structure with full management and legal representation powers, or establish your own legal entity (MEI not permitted). The CNPJ must include, as primary or secondary economic activity (CNAE), the codes 86.50-0-99 or 86.60-7/00. • Specialization: Postgraduate degree or specialization in Medical Auditing and/or Legal area, preferably with emphasis on Supplementary Health (private health insurance sector). • Solid experience in Retrospective Medical Auditing (analysis of accounts and medical records). • Proven prior experience with medical and hospital billing tables. • Proficiency in CBHPM. • Intermediate/advanced knowledge of Microsoft Office (Office suite). • Previous experience working at health insurers / health plan operators.