Sr Financial Clearance Specialist Center for Surgical Weight Loss OHO
Location: Nashville, Tennessee
Internal Number: 2113263
Sr. Financial Clearance Specialist
Your Role: Performs and documents pre-certification from insurance companies for all elective surgeries and visits, with minimal guidance.
Qualifications: High School Diploma or GED (or equivalent experience) and 4 years relevant experience
Shift: Monday - Friday 8:00 AM - 5:00 PM
Discover Vanderbilt University Medical Center:
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 -- of culture, thinking, learning and leading -- 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. Vanderbilt's mission is to advance health and wellness through preeminent programs in patient care, education, and research.
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 Adult Hospital in Tennessee and metropolitan Nashville, named to the Best Hospitals Honor Roll of the top 20 adult hospitals, 10 nationally ranked adult specialty programs, with 3 specialties rated in the top 10 nationally, Monroe Carell Jr. Children's Hospital at Vanderbilt named as one of the Best Children's Hospital in the nation, with 10 out of 10 pediatric specialties nationally ranked.
* Healthcare's Most Wired: Among the nation's 100 "most-wired" hospitals and health systems for its efforts in innovative medical technology.
* Becker's Hospital Review: named as one of the "100 Great Hospitals in America", in the roster of 100 Hospitals and Health Systems with Great Oncology Programs and to its list of the 100 Hospitals with Great Heart Programs.
* The Leapfrog Group: One of only 10 children's hospitals in the to be named at Leapfrog Top Hospital.
* American Association for the Advancement of Science: The School of Medicine has 112 elected fellows
* Magnet Recognition Program: Received our third consecutive Magnet designations.
* National Academy of Medicine: 22 members, elected by their peers in recognition of outstanding achievement
* Human Rights Campaign Healthcare Equality Index: 6 th year in a row that Vanderbilt University Medical Center was a Leader in LGBTQ Healthcare Equality.
Obtains certification from insurance companies for all elective out-patient specialty surgeries for both the surgeon and the facility.
Contacts insurance review agencies to request authorization.
Handles problematic certification cases with relevant internal groups.
Performs investigative and follow-up work on cases with pre-certification issues until the issue is resolved.
Documents certification process in the appropriate applications to facilitate accurate concurrent review, billing and reimbursement.
Coordinates co-pays or monies to be collected from the patient.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
INSURANCE REGULATORY KNOWLEDGE (ADVANCED): - 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 (INTERMEDIATE): - 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 (INTERMEDIATE): - The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.
PROBLEM SOLVING (INTERMEDIATE): - 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.
Organizational Impact: Performs non-routine tasks that significantly impact team's performance with minimal guidance.
Problem Solving/ Complexity of work: Conducts research and analysis to solve some non-routine problems.
Breadth of Knowledge: Applies broad job knowledge and has basic job skills in other areas.
Team Interaction: Provides informal guidance and support to less experienced team members.
SUPPORTING COLLEAGUES (S3):
- Develops Self and Others: Continuously improves own skills by identifying development opportunities.
- Builds and Maintains Relationships : Seeks to understand colleagues' priorities, working styles and develops relationships across areas.
- Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner.
DELIVERING EXCELLENT SERVICES (S3):
- Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service.
- Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns to supervisors in a timely manner.
- Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support.
ENSURING HIGH QUALITY (S3):
- Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards .
- Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond.
- Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department.
MANAGING RESOURCES EFFECTIVELY (S3):
- Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service.
- Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources.
- Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error.
FOSTERING INNOVATION (S3):
- Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them.
- Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action.
- Adapts to Change: Embraces change by keeping an open mind to changing plans and incorporates change instructions into own area of work.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.