• Acts as the liaison between key client contacts and our denials and underpayment appeal process to the appropriate payer. • Responsible for facilitating payment review recovery efforts for denied and underpaid accounts for assigned clients, thereby increasing the department's revenue. • Responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information. • Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims. • Use payment documentation provided by payers and medical provider contract information to determine the correct reimbursement. • Efficiently review hospital contracts to identify and collect cash payments from insurance companies. • Research, request, and acquire all pertinent medical records and supporting documentation to create and submit complex underpayment appeals. • Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received. • Ensures smooth operations and improves customer satisfaction.

• Realizar auditoria retrospectiva de contas hospitalares e ambulatoriais de forma 100% remota; • Analisar prontuários, faturamentos e despesas médicas utilizando o sistema Facplan; • Avaliar a pertinência técnica das cobranças de materiais, medicamentos, diárias e taxas; • Elaborar relatórios analíticos e pareceres técnicos referentes às auditorias retrospectivas concluídas; • Atuar na análise de recursos de glosas (quando aplicável ao fluxo retrospectivo).

• Perform centre audit/monitoring activities with new and existing centres to ensure compliance with LanguageCert’s centre approval criteria and associated policies and procedures • Provide centres with clear and constructive advice, support and guidance with regard to internal quality arrangements and LanguageCert’s qualifications, policies and procedures and regulatory requirements • Carry out announced and/or unannounced visits to monitor the conduct and integrity of examinations • Carry out audit activities to verify the compliance of a new examination room/venue according to LanguageCert’s set specifications • Complete accurate centre audit reports/records, written in a clear and constructive manner, returning them to LanguageCert and the centre no later than 5 business days after the audit activity • Inform centres of any identified non-compliance and actions required to remedy • Monitor and follow-up on identified centre non-compliance to ensure appropriate close out of actions required • Recommend to the Quality Officer sanctions to be imposed on centres • Undertake investigations regarding alleged malpractice / maladministration as assigned by the Quality Officer • Demonstrate full understanding and implementation of LanguageCert’s systems, process, policies and procedures to ensure compliance with internal Management Systems • Provide any audit clarifications required • Attend training/standardisation events from time-to-time throughout each calendar year • Declare any existing or prior activities which would/may conflict with the role of QA and report, in writing, any conflicts that may, from time-to-time occur • Act as a goodwill ambassador for LanguageCert by the courteous treatment of all customers, ensuring at all times that the professionalism of the company is upheld • Maintain own Health & Safety and that of LanguageCert staff and candidates in accordance with the company’s Health & Safety requirements.

Role Description PeopleCert, on behalf of LanguageCert, is seeking Quality Auditors (QAs) on a project basis to ensure that approved centres comply with LanguageCert and regulatory requirements. This role involves conducting external quality assurance audits to assess a centre’s infrastructure, systems, and internal quality assurance arrangements. The QA will verify that processes and practices are effectively implemented and aligned with LanguageCert’s standards. - Perform centre audit/monitoring activities with new and existing centres to ensure compliance with LanguageCert’s centre approval criteria and associated policies and procedures. - Provide centres with clear and constructive advice, support and guidance with regard to internal quality arrangements and LanguageCert’s qualifications, policies and procedures and regulatory requirements. - Carry out announced and/or unannounced visits to monitor the conduct and integrity of examinations. - Carry out audit activities to verify the compliance of a new examination room/venue according to LanguageCert’s set specifications. - Complete accurate centre audit reports/records, written in a clear and constructive manner, returning them to LanguageCert and the centre no later than 5 business days after the audit activity. - Inform centres of any identified non-compliance and actions required to remedy. - Monitor and follow-up on identified centre non-compliance to ensure appropriate close out of actions required. - Recommend to the Quality Officer sanctions to be imposed on centres. - Undertake investigations regarding alleged malpractice/maladministration as assigned by the Quality Officer. - Demonstrate full understanding and implementation of LanguageCert’s systems, process, policies and procedures to ensure compliance with internal Management Systems. - Provide any audit clarifications required. - Attend training/standardisation events from time-to-time throughout each calendar year. - Declare any existing or prior activities which would/may conflict with the role of QA and report, in writing, any conflicts that may, from time-to-time occur. - Act as a goodwill ambassador for LanguageCert by the courteous treatment of all customers, ensuring at all times that the professionalism of the company is upheld. - Maintain own Health & Safety and that of LanguageCert staff and candidates in accordance with the company’s Health & Safety requirements. Qualifications - Exceptional command of the English language (native-like fluency or C2 level certification preferred). Certifications such as LanguageCert C2 LTE or C2 IESOL are a plus. - Relevant quality assurance experience in the context of training and/or examination. - Familiarity with equal opportunities and anti-discriminatory practices. - Availability on demand, at short notice from time-to-time; frequent travelling may be required. - Efficient completion of administrative duties, including completion of reports in a timely manner. - Representation of LanguageCert in a firm, but professional and polite manner. - Ability to communicate and nurture and develop effective professional working relationships. - Ability to meet deadlines and keep to schedules. - Punctuality and reliability, maintaining high levels of integrity at all times. - Exceptional attention to detail. Benefits - Competitive remuneration package 💲 - Work in an international, dynamic and fun atmosphere 💯 - Huge learning experience in using best practices and global environment 📈 - Constant personal and professional development 🥇 Company Description PeopleCert is a global leader in assessment and certification of professional skills, partnering with multi-national organizations and government bodies for the development & delivery of standardized exams. Delivering exams across 200 countries and in 25 languages over its state-of-the-art assessment technology, PeopleCert enables professionals to boost their careers and realize their life ambitions. - Quality, Innovation, Passion, Integrity, Clarity, and Velocity are the core values which guide everything we do. - Our offices in UK, Greece, Cyprus, and India boast a culture of diversity, where everyone is different, yet everyone fits in. - All of us at PeopleCert are committed to the reflection of the diversity and inclusion of our customers and the communities in which we do business.