Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded and your abilities challenged. It is a place where your diversity â of culture, thinking, learning and leading â is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbiltâs mission is to advance health and wellness through preeminent programs in patient care, education, and research.
JOB SUMMARY: Financial Clearance reports to the Supervisor â Financial Clearance and is responsible for the financial clearance of patient accounts for Vanderbilt University Medical Centerâs (VUMC) technical and professional revenue cycle encompassing Vanderbilt University Hospitals & Clinics as well as Vanderbilt Medical Group.
Independently manage the daily work to confirm eligibility of patient coverage benefits, including coverage limits, number of days, patient responsibility and effective dates
Obtain authorization, pre-certification, referral and / or notification as necessary prior to the date of service
Obtain and supply payor documentation required to obtain authorization, pre-certification and / or referrals timely and accurately
Prioritize accounts according to date of service to ensure all patients are cleared timely and prior to the expected date of service
Follow-up with patient and / or referring physician office in the event financial clearance is unable to be obtained prior to date of service
Monitor assigned financial clearance worklists daily to ensure all assigned accounts are completed per staff productivity expectations
Identify and refer patients to Financial Counseling per department guidelines when applicable
Maintain appropriate records, files and accurate documentation in the revenue cycle systems
Focus on achieving or exceeding standard performance expectations for daily activities
Dedication to treating patients and internal staff as clients / customers, maintaining a flexible customer service approach and orientation that emphasizes service and quality
Comply with established policies, processes, financial assistance and quality assurance programs
Recommend new approaches for enhancing performance and productivity when appropriate
INSURANCE REGULATORY KNOWLEDGE - Demonstrates knowledge of the appropriate rules and regulations for insurance policies, claims, payment and coverage. Ability to interpret and explain rules and regulations that are ambiguous or unclear.
CUSTOMER SERVICE - A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs.
DATA ENTRY - The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.
PROBLEM SOLVING - Uses critical thinking and process improvement i.e. coaches and mentors development of problem statement, describes current state, identifies root causes, creates future state, coaches and mentors development of solutions and action plans with a sustainability plan. Applies appropriate tools to address issues.
Additional Position Requirements:
Exceptional communication, customer service skills, and phone etiquette
Prior clinical experience and/or general understanding of specific procedure criteria evaluated to obtain authorizations, in addition to InterQual and Millman criteria
Knowledge of third party sponsorship opportunities such as Cobra, SSI/SSD, Medicaid, Medicare, Health Exchanges, VUMC Charity Policy and other assistance programs available to patients
Knowledge of the government and non-government third party benefits and coverage rules
Fluent in languages other than English, (i.e. Spanish) preferred
Clear understanding of the impact financial clearance services have on revenue cycle operations and financial performance
Knowledge of payor requirements, coverage guidelines, authorizations and pre-certifications requirements
Familiarity with customer service expectations, computer processing and medical and billing office terminology
Ability to work independently with little direction while managing multiple tasks simultaneously, prioritizing issues as they arise and escalating issues when appropriate
VUMC Recent Accomplishments:
Because we are committed to providing the best in patient care, education and research, we are proud of our recent accomplishments:
US News & World Report: #1 Hospital in Tennessee, #1 Health Care Provider in Nashville, #1 Audiology (Bill Wilkerson Center), 12 adult and 10 pediatric clinical specialties ranked among the nation's best, #15 Education and Training
Truven Health Analytics: among the top 50 cardiovascular hospitals in the U.S.
Becker's Hospital Review: one of the "100 Greatest Hospitals in America"
The Leapfrog Group: grade "A" in Hospital Safety Score
National Institutes of Health: among the top 10 grant awardees for medical research in the US
Magnet Recognition Program: Vanderbilt nurses are the only group honored in Middle Tennessee
Nashville Business Journal: Middle Tennessee's healthiest employer
American Hospital Association:among the 100 "Most Wired" medical systems in the US
Vanderbilt University Medical Center is a comprehensive health care facility dedicated to patient care, research, and biomedical education. Our reputation for excellence in these areas has made us a major center for patient referrals from throughout the Mid-South. Each year, people throughout Tennessee and the Southeast choose Vanderbilt University Medical Center for their health care because of our leadership in medical science and our dedication to treating patients with dignity and compassion.The mission of Vanderbilt University Medical Center is to advance health and wellness through preeminent programs in patient care, education, and research.