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Denial Appeals Analyst, Mid-level
Unimed NacionalManaging glosa processes and reporting for Unimed's healthcare services. Ensuring compliance and financial mitigation in São Paulo operations.
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Excelbilling modulesdenial appeal processesbilling/tariff tables
Soft Skills
detail-orientedorganizedstrong communication skills
Certifications
Bachelor’s degree