Gregory Silva Email & Phone Number

São Paulo, Brasil

Realizando testes e análise, com avaliação dos processos de controles internos e identificando eventuais falhas e propondo melhorias para mitigar riscos operacionais.Executando auditorias internas de acordo com as normas e procedimentos estabelecidos, verificando a conformidade das operações e transações com as políticas da empresa.Participando ativamente.

São Paulo, Brasil

• Análise de pagamentos e glosas com base nas regulamentações da ANS e correções dos processos encaminhados pelos prestadores de serviços, bem como a regulamentação de custos hospitalares;- Análises e pagamentos de.
• Realização de auditorias técnicas para prevenção de sinistros, analisando recorrências de sinistros por regiões para evitar fraudes;
• Desenvolvimento de planilhas e dashboards com o faturamento semanal e mensal com custos… Show more
• Desenvolvimento de planilhas e dashboards com o faturamento semanal e mensal com custos de internação, honorários médicos e custos com materiais especiais; Show less

São Paulo E Região, Brasil

• Participation in the document scanning project for requesting reimbursements from hospitals, achieving perfection in scanned image quality to enable document analysis;
• Updating historical documentation and new documentation within the Salesforce system (APS 2.0), where the system reads the documentation and populates the data, streamlining the processes analysis and approval;
• Analysis of payments and disallowances based on ANS regulations and corrections of processes forwarded by… Show more
• Analysis of payments and disallowances based on ANS regulations and corrections of processes forwarded by service providers, along with hospital cost regulation;
• Conducting technical audits to prevent claims and analyzing claims recurrence by region to prevent fraud;
• Elaboration of reports using Tableau to identify potential fraud hotspots and intensification of individual analysis of documentation and comparison with service request history, resulting in a 35% reduction in company.

São Paulo E Região, Brasil

• Elaboration of controls and analysis of reports of all procedures performed for each operator on hospitalized and discharged patients;
• Transmission of medical bills to operators;
• Requests for rate extension, exams, medications, and surgical procedures performed on hospitalized patients;
• Assisting physicians and nurses in external audits to negotiate disallowances (invoices not received) and hospitalization costs, preparing all materials in advance and presenting documents to… Show more
• Assisting physicians and nurses in external audits to negotiate disallowances (invoices not received) and hospitalization costs, preparing all materials in advance and presenting documents to physicians more quickly.
• Development of spreadsheets and dashboards for weekly and monthly billing of hospitalization costs, medical fees, and special materials costs;

São Paulo E Região, Brasil

• Development of reports to monitor surgical procedures by date and procedure type;
• Requests for surgeries and special materials must be submitted to health plans as quickly as possible.

São Paulo E Região, Brasil

• Responsible for the administrative process of hospitalization requests for health insurance, including the separation of all required documentation as quickly as possible;
• Health operator requests for OPMEs (Orthoses, Prostheses, and Special Materials).

São Paulo, São Paulo, Brasil

• Registration of hospital documentation in the hospital's internal system as well as receipt of invoices from external services, aiming for compliance with all procedures with precision;
• In-person and over-the-phone customer service.