Interview with Darlan Figueiredo Guedes 

Medical Accounts and Exchange Coordinator – Unimed Extremo Sul

Tell us a summary of your professional career.

I started my career in 2007 as a Medical Accounts Assistant at Unimed Extremo Sul. I soon became interested in the area and sought to expand my knowledge. I studied Hospital Administration and Management, participated in various specializations, seminars, courses, workshops and workshops at the Unimed System. In 2017, with 10 years of experience, I faced the challenge of leading the Medical Accounts and Exchange area at Unimed Extremo Sul, a role I currently perform.

What was your problem before you met SAUDI?

There were many. List the main ones below:

– Time to become aware of an expense – Accounts were posted 30 days or more after the expense. We became aware of hospital expenses long after its actual use;

– Difficulties in carrying out retrospective and concurrent audits (on site) – The retrospective audit process was extremely time-consuming and manual, analyzing paper guides and passing on the glosses to the system (rework). Furthermore, concurrent audits or on site they were exhausting and costly, as we needed to deploy a technical auditor to carry out face-to-face analyzes of many medical records in hospitals;

– High volume of disallowances in providers – This strained the operator’s relationship with providers, generated an absurd amount of disallowance resources and consumed precious team time;

– Account analysis time too long – Since we did not have validations when entering the account into the system, it was necessary to arrive at the basic contract rules, authorizations, validity, etc.;

– Lack of validations when entering the account.

How did you find out about SAUDI and why did you decide to give it a vote of confidence?

The commercial team contacted my manager, who at the time invited the then sector coordinator (we were in the process of transitioning coordination) to a video conference where the tool would be presented. We were focused on optimizing our processes and the solutions presented harmonized with our interests.

It gave us confidence that the SAUDI (VOXIS) is already used by other units of the Unimed System.

Tell us a little about the difficulties you had when starting to use SAUDI.

The Unimed system has many peculiarities and contemplating the various local rules and agreements was initially a challenge. In addition to training the accredited network and establishing a flow with reasonable deadlines for the operator and providers. Basically there were more strategic difficulties, not operational ones.

What are the results and transformation that the product has brought to your routine at the operator?

We have good results such as a reduction in the time spent analyzing accounts, an almost total reduction in retroactive disallowances, elimination of appeals for disallowances (since there is no disallowance, there is no appeal), anticipation of knowledge of expenses, among other results. This allowed for a reduction in the team exclusively dedicated to account processing.

What happened at your operator after obtaining the results through SAUDI, that you never imagined would be possible?

Anticipating time to know expenses, which is essential for our business.

After implementing SAUDI, which processes became easier within your operator?

Parameterization of validations when posting the account, parameterization of very detailed agreements and policies and general analysis of the account has become much simpler. I mainly highlight accurate and uncomplicated statistical and managerial data analysis.

How long did it take to notice cost control and reduction after implementing SAUDI?

We implement the SAUDI (VOXIS) in the accredited network gradually, using the largest provider as a pilot and extending it to the others. In general terms, we can understand the reduction in costs from the 6th month.

On average, how many percent did SAUDI help reduce your operator's costs? What about medical disallowance processes?

I will only respond in the medical glossing processes, in which we had a reduction of 94% in the total volume of glosses.

Currently, in your day-to-day life as a manager, what is your main problem/pain that you face in your account management work?

Reconcile growing demands with increasingly tight deadlines, all while respecting the sector's numerous rules with ethics and transparency.

Would you like to suggest any improvements to SAUDI? If so, which ones? 

Yes.

– Improvement in the parameters of the Exchange Report (for Accounts above R$15 thousand) making it more automated by automatically filling in beneficiary and hospitalization data;

– Improvement in the “Guides under negotiation” process – Currently, both the guides sent by the nursing audit profile and the administrative profile are returned for analysis in the same place, requiring the analyst to verify whether the questioning carried out is up to their own action or that of someone else.

– Improvement in Account Analysis filters – Currently the analyst can apply several filters before starting to analyze accounts, such as filtering by “post date” choosing to analyze the accounts that were posted first. However, when analyzing the first account and returning to the previous menu, the applied filter is not maintained, for default returns to the predefined configuration. I have already opened calls dealing with this matter without success.

– Modernization of the management reports interface – Add graphics and dashboards improves the end result of the product and makes it more compatible with 2020.

Do you recommend the SAUDI system?

No doubt! Our experience with SAUDI (VOXIS) is very well evaluated so far and although we have room for improvement, we highly recommend it.