Responsibilities

• Assist in monitoring contracted providers, supporting analysis of relationship practices and recommending improvements.
• Support the provider credentialing and de-credentialing processes, including initial contact, receipt of documentation, updating records, and communicating decisions.
• Contribute to initiatives and analyses aimed at network revitalization, assisting in mapping local needs, identifying potential partners, and maintaining the balance between service supply and demand.
• Support control of payment schedules and monitoring of claim denials (glosas).
• Maintain relationships with providers, handling strategic requests for immediate service absorption.
• Support the interface with the medical claims/accounts department, assisting in identifying and resolving inconsistencies.
• Contribute to market surveys and research, using tools such as inflation indices and internal data analysis (e...