Auditor

• Provide strategic technical support to procurement and credentialing teams in contracting and negotiation with healthcare partners
• Define reimbursement benchmarks to identify cost-optimization opportunities and ensure quality of care
• Continuously monitor the volume and appropriateness of diagnostic testing
• Audit inpatient procedures and ICU length of stay
• Produce critical reports for hospital cost control and sustainable claims management
• Conduct technical site visits to identify gaps and propose corrective actions aligned with industry quality certifications
• Assess the clinical appropriateness of regulated procedures
• Analyze the health profile of new clients to identify preexisting conditions and direct specific coverage decisions
• Perform technical evaluations and interviews during the new-sales process
• Lead and mentor the nursing team
• Develop utilization indicators to map cost variability and structure new care packages and clinical protocols

C2

Medical Auditor