Medical Auditor, Retrospective

This is a fully remote position, open to applicants in Brazil.

📋 Description

• Conduct retrospective audits of medical billing, performing detailed technical analyses of hospital accounts to ensure adherence to the care delivered, billed items, medical protocols, and contractual agreements.

• Manage regulatory affairs and collaborate with the National Supplementary Health Agency (ANS) by drafting medical opinions and technical responses to Preliminary Intermediation Notifications (NIP) and official correspondence.

• Develop technical responses and defenses for Notices of Infraction issued to the ANS, working closely with legal and regulatory teams.

• Identify discrepancies in care delivery and recommend corrective actions to guarantee compliance with established standards in the supplementary health sector.

⛳️ Requirements

• Education: A medical degree with an active and valid registration with the Regional Medical Council (CRM).

• Company registration (CNPJ): Must be part of the company's shareholder structure with full management and legal representation authority, or establish a legal entity (individual micro-entrepreneur status is not accepted). The CNPJ should include one of the following codes as a primary or secondary economic activity (CNAE): 86.50-0-99 or 86.60-7/00.

• Specialization: A postgraduate degree or specialization in Medical Audit and/or Legal fields, preferably with a focus on Supplementary Health.

• Extensive experience in Retrospective Medical Auditing, including analysis of billing/accounts and medical records.

• Demonstrated experience with medical and hospital billing fee schedules.

• Proficient understanding of CBHPM (Brazilian Hierarchical Classification of Medical Procedures).

• Intermediate to advanced proficiency in Microsoft Office applications.

• Previous experience working with health plan operators or healthcare payers.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Opportunities for professional development and continuing education.

• Flexible working hours and a supportive work environment.