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Auditor Nurse – Denial Management
Hospitalcare Products Co.. Conduct technical and critical analyses of initial claim denials, identifying causes, trends, and financial impacts.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in denial management, root cause analysis, and compliance assessment within the healthcare revenue cycle. Proficient in developing performance indicators and preparing executive reports to drive decision-making and financial recovery.
Highest-signal resume keywords
Denial ManagementRoot Cause AnalysisHealthcare AuditingClaims AuditingAdvanced Excel
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Root Cause Analysis ToolsFinancial Indicator InterpretationClaims AuditingDenial AnalysisCompliance Assessment
Soft Skills
Analytical ThinkingCommunicationCollaboration
Tools & Technologies
AI ToolsHospital Information SystemsMVTasyTUSSCBHPMSIMPROBRASÍNDICE
Certifications & Qualifications
Graduate Degree in Healthcare Auditing
Industry Keywords
Revenue CycleHealth Insurance ContractsBilling RulesRegulatory RequirementsFinancial Recovery
About the role
Key responsibilities & impact- Conduct technical and critical analyses of initial claim denials, identifying causes, trends, and financial impacts.
- Perform detailed analyses of denials by health insurance provider, hospital unit, specialty, process, and denial reason.
- Assess the compliance of clinical, administrative, and billing processes with contracts, fee schedules, billing rules, and regulatory requirements.
- Identify opportunities for financial recovery and mitigation of recurring losses.
- Lead root cause analyses using structured methodologies (5 Whys, Ishikawa, GUT, RCA, Pareto, among others).
- Support operations, billing, concurrent review, and denial appeals teams in interpreting insurers’ findings.
- Develop and monitor performance indicators related to denials and improvement opportunities.
- Prepare executive reports, dashboards, and management presentations to support decision-making.
- Participate in corporate meetings with hospital units and multidisciplinary teams to discuss results and action plans.
- Serve as a technical reference for interpreting clinical rules, contracts, and insurers’ audit criteria.
- Propose preventive and corrective actions to reduce the recurrence of identified denials.
- Support other Revenue Cycle teams as required by the department.
Requirements
What you’ll need- Graduate degree in Healthcare Auditing or a related field.
- Knowledge of the hospital revenue cycle, including claims auditing.
- Denial management and appeals.
- Use of AI tools.
- Health insurance contracts and reimbursement rules.
- TUSS, CBHPM, SIMPRO, and BRASÍNDICE fee schedules.
- Ability to interpret clinical and financial indicators.
- Root cause analysis tools.
- Basic knowledge of advanced Excel.
- Hospital information systems (MV, Tasy, or equivalent).
Benefits
Comp & perks- Meal and food allowance – Pluxee (Sodexo) multi-benefit card.
- Transportation allowance (provided on a card).
- Health insurance – 2Care Vera Cruz Campinas, including dependents.
- Dental insurance – Amil Dental, including dependents.
- Childcare assistance for female HC employees (children up to 6 years old).
- Life insurance.
- Wellhub (Gympass), including dependents.
- SESC partnership, including dependents.
- Profit-sharing.
- Financial assistance for courses.
- Training platform.