of Brazilian companies struggle to hire qualified professionals
of billing, auditing, authorization and denial jobs were temporary
of hospital billing is denied at entry: 1 in every 6 reais
average time for hospitals to get paid by health plans, counted from claim submission
Automating an understaffed operation only speeds up the errors.
- 1HireCompetes for talent with payers and consultancies.
- 2TrainMonths until they master rules, packages and contracts.
- 3LoseThey leave and take the knowledge with them.
- 4Start overMeanwhile, denials grow and the backlog piles up.
Private healthcare opens jobs faster than it trains people: openings grow 5.3% a year, and 81% of Brazilian companies can't find qualified professionals. The most sought-after roles are precisely those in the revenue cycle, such as billing, authorization and nurse auditing.
Payers, consultancies and hospitals compete for these people in a permanent salary auction. And more than 90% of these openings in 2022 and 2023 were temporary: the sector hires billing specialists as a project and is surprised when they leave.
When they leave, they take each payer's rules, packages and contracts with them. The hospital starts over, while almost 16% of billing is denied at entry and the collection period reaches 77 days.
Hospitals don't need another system. They need people who know how to use it, and management that makes them stay.
Turnover cost
Recruiting, training, months of ramp-up and the tacit knowledge that walks out the door. Repeated with every replacement.
Vacancy cost
The denial no one contests because there's no analyst in the seat. The claim that closes late because the backlog grew.
Opportunity cost
Leadership spending energy managing the billing department instead of care, physicians and expansion.
Sources: Robert Half, Healthcare Sector Outlook, 2024; ManpowerGroup, Talent Shortage, 2025; Anahp, Observatory Report, 2026.
Four things the market doesn't offer billing specialists.
We offer all of them.
Continuous training
40% of Brazilian companies already respond to the shortage by training in-house. A hospital can't build that school on its own. We did: Accrua University has tracks by payer, claim type and specialty. Training is a monthly routine with assessments, not an onboarding event.
Merit-based pay
In the market, a nurse auditor earns between R$ 4,750 and R$ 10,300. Whoever pays by the salary table loses senior staff to whoever pays for results. Every Accrua professional has individual productivity and quality KPIs, and those who deliver more earn more.
Technology that takes away the tedious work
AI pre-audits the claim, cross-checks the medical record against charges, flags discrepancies, classifies denials and builds the appeal. The professional decides; the machine prepares.
A career, not a job
A path from junior to senior auditor and operations lead, with public criteria. Hands-on management, weekly performance rituals, recognition. People who see a future don't leave.
The result is an operation that doesn't depend on two key people.
Sources: ManpowerGroup, Talent Shortage, 2025; Robert Half, Healthcare Sector Outlook, 2024.
AI does what doesn't need people.
Auditors do what only people can.
- Automatic claim pre-audit against medical record and contract
- Denial classification and prioritization by value and likelihood of reversal
- Denial appeal building with suggested technical justification
- Tracking each payer's deadlines, pending queue and alerts
- Real-time KPIs by professional, payer and unit
- Integration with the hospital's HIS
- Reads the clinical notes and confirms the charges reflect the care delivered
- Decides on high-cost materials and drugs, OPME, daily rates and packages
- Negotiates discrepancies with the payer's auditors, as equals
- Identifies the root cause of denials and tells the hospital what needs to change in the process
- Trains the next generation
You see all of this on the same dashboard our management uses. Transparency isn't a feature: it's how we work.
From targeted support to full operations.
The hospital chooses the size of the step.
Team augmentation
Hospitals with a good team that is short-staffed or overloaded at one point in the cycle: denial appeals, auditing for one payer, a backlog.
Accrua professionals integrated into your workflow, with our technology and our KPIs.
The hospital. We report.
Managed operations
Hospitals that want predictability and accountability for results, by unit, payer or claim type.
We take over the operation, with SLA, targets and fees tied to performance.
Shared governance: the hospital sets the rules, we deliver the numbers.
Operational rebuild
Hospitals that have lost their team, are opening a new unit or want to rebuild the department from scratch.
We structure, operate and gradually transfer knowledge to the hospital's team, at its own pace.
It starts with us and ends with the hospital. No dependency.
No disruption. In waves,
with the hospital in charge of every step.
Assessment
We map where the cycle is losing money: denials by payer and reason, time by step, backlog, dependency on people. We deliver a report sizing the opportunity, even if you don't sign.
Integration and transition
We connect the platform to the HIS, define rules and SLAs with your team and come in waves: by payer, unit or claim type. Nothing migrates all at once.
Operations and continuous improvement
Weekly KPI rituals, monthly reviews with leadership, quarterly targets. Every reversed denial becomes a process adjustment so it doesn't happen again.
At every phase, the hospital knows exactly what's happening, with whom and with what result.
The capacity to bill is the capacity to grow.
Two calculations every CFO does in their head.
Each percentage point of initial denials, in a hospital with R$ 100 million in gross revenue, is R$ 1 million in dispute with the payer.
Every 10 days shaved off the collection period, in a R$ 150 million hospital, is R$ 4 million in cash.
The collection period (77 days) exceeds the payment terms for fixed costs by 29 days, and the sector's average EBITDA margin has fallen to 11%. Working capital tied up in denials and payment delays is now the number one problem for hospital CFOs.
Source: Anahp, Observatory 2026.
Questions every executive asks before outsourcing billing.
Will I lose control of my revenue cycle?
No. The hospital sets the rules, policies and targets; we execute and report. You see the same dashboard our management sees, in real time, and we have fixed governance rituals: weekly with operations, monthly with leadership.
How do you protect patient data and comply with LGPD?
Role-based access, an audit trail for every action, a contract with LGPD and professional confidentiality clauses. Details are in our Trust Center.
Is this BPO or software?
It's a revenue cycle service. The difference from a typical BPO is who does the work (nursing-trained professionals, continuously trained and well paid) and with what (a proprietary AI platform that eliminates repetitive work). The difference from software is that we deliver the result, not the tool.
Do I need to replace my system (MV, Tasy, SOUL…)?
No. Our platform integrates with your HIS. We amplify what already exists.
What happens to my current team?
It depends on the model. With augmentation, they stay and get support. With managed operations, we can absorb, train or work side by side, as defined in the contract. With a rebuild, we train your team to take over. In all of them, Accrua University is available to the hospital's team.
Will I become dependent on Accrua?
The data belongs to the hospital, the integration is documented and the rebuild model exists precisely to transfer knowledge. Exit and transition clauses are in the contract.
How does pricing work?
The idea is to turn a fixed cost you don't control (payroll, turnover, vacancies) into a variable cost tied to results. The format depends on the engagement model, and the assessment sizes the proposal.
How long until I see results?
The assessment comes first. The wave-based transition starts showing KPIs from the very first wave, and denials and payment times fall consistently in the following months.