Hospitalcare Products Co. distributes medical supplies and equipment to healthcare facilities. Operating in the medical equipment manufacturing sector, the company helps providers source products essential to their day-to-day care and operations.
Nurse Auditor, Denial Management
Review claim denials, contracts, and financial indicators at Hospital Care. Help hospitals and operational teams recover revenue and reduce losses.
Aprašymas
- Analyze initial claim denials to identify causes, trends, and financial impact.
- Break down denials by insurer, hospital, specialty, process, and reason.
- Check clinical, administrative, and billing processes against contracts, fee schedules, billing rules, and regulations.
- Find opportunities to recover revenue and limit recurring losses.
- Lead root cause reviews using methods such as 5 Whys, Ishikawa, GUT, RCA, and Pareto.
- Help operations, billing, concurrent review, and appeals teams interpret insurers’ findings.
- Track denial performance indicators and identify areas for improvement.
- Prepare executive reports, dashboards, and presentations to inform decisions.
- Join corporate meetings with hospital units and multidisciplinary teams to review results and action plans.
- Advise on clinical rules, contracts, and insurers’ audit criteria.
- Recommend preventive and corrective measures to reduce repeat denials.
- Support other Revenue Cycle teams as needed by the department.
Reikalavimai
- Degree in Healthcare Auditing or a related field.
- Knowledge of hospital revenue cycles and claims auditing.
- Experience with denial management and appeals.
- Ability to use AI tools.
- Knowledge of health insurance contracts and reimbursement rules.
- Familiarity with TUSS, CBHPM, SIMPRO, and BRASÍNDICE fee schedules.
- Ability to interpret clinical and financial indicators.
- Knowledge of root cause analysis tools.
- Basic proficiency in advanced Excel.
- Experience with hospital information systems such as MV, Tasy, or equivalent.
Privalumai
- Meal and food allowance through the Pluxee (Sodexo) multi-benefit card.
- Transportation allowance provided on a card.
- Health insurance through 2Care Vera Cruz Campinas, including dependents.
- Amil Dental coverage, including dependents.
- Childcare assistance for female HC employees with children up to age 6.
- Life insurance.
- Wellhub (Gympass) membership, including dependents.
- SESC partnership, including dependents.
- Profit-sharing.
- Financial assistance for courses.
- Training platform.