Crocs Store Manager, IOI City Mall
Crocs, Inc.Lead Crocs store operations, sales, customer service, and team development at IOI City Mall in Putrajaya. Oversee visual presentation, inventory, point-of-sale processes, and daily performance.
Atvērt
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.
Apraksts
- 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.
Prasības
- 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.
Priekšrocības
- 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.
Saistītās vakances
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