Denial Appeals Analyst, Mid-level

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🕒 4 days ago

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Unimed Nacional

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

⚕️ Healthcare Insurance

👥 B2C

🤝 Non-profit

Healthcare Insurance • B2C • Non-profit

Unimed Nacional is an organization that provides various healthcare services and benefits for its members, aiming to enhance access to medical care in Brazil. It operates within a network of healthcare professionals and facilities to offer comprehensive health solutions to individuals and families.

📋 Description

• Identify daily the receipt of billing responses or denial reports issued by the payer/operator. • Establish priorities for execution and set response deadlines for appeals, ensuring process integrity and mitigating negative financial impacts. • Liaise with support and customer service teams to validate denial annotations. • Prepare justification reports with accurate information to submit to the payer/operator. • Support internal teams by reporting weaknesses that caused denials so that clinical or operational processes can be corrected. • Prepare monthly reports and indicators demonstrating the evolution of denials, and present the action plans applied. • Work collaboratively with involved areas, focusing on alignment and continuous improvement. • Resolve possible billing discrepancies with relevant teams promptly, ensuring the appeals response occurs according to contractual agreements.

🎯 Requirements

• Education: Bachelor’s degree completed. • Software and Tools: Proficiency with Excel spreadsheets. • Skills and Competencies: Detail-oriented, organized, strong communication skills, understanding of the revenue cycle, and awareness of the importance of timely deadline compliance. • Business Knowledge: Must understand clinical/care workflows, service processes, and the complexity of differentiated contractual agreements. • Nice-to-have (Desired Knowledge): Experience with operational systems’ billing modules, billing/tariff tables, and denial appeal processes.

🏖️ Benefits

• Health Insurance: Outpatient, hospital and obstetric coverage for you and your legal dependents. • Dental Insurance: Company-subsidized plans covering basic procedures through orthodontics and prosthetics. • Pharmacy Agreement: Access to purchasing medications through a network of partner pharmacies with payroll discounts and limits based on salary. • Wellhub (Gympass): Wellbeing platform providing access to gyms and health apps, extendable to up to 3 dependents. • Meal Card: Daily credit for meals for each working day. • Food Allowance Card: Monthly credit to assist with grocery purchases. • Private Pension: Company-established plan to help build financial reserves and future income. • Life Insurance: Coverage for death and disability, providing financial protection for you and your family. • PPR (Results Participation Program): Annual reward based on achieving the cooperative's collective goals. • Transportation Voucher: Available for commuting between home and work for on-site or hybrid arrangements. • Parking: Agreements with parking facilities near company locations. • Day Off: One day off granted after your birthday for personal use. • Family Support: Childcare or nanny assistance for employees with children up to 16 months old. • Benefits Club: Partnerships and discounts with educational institutions, language schools, and leisure providers.