Lead Account Reimbursement Specialist - Specialty Billing, One Hundred Oaks
In your pivotal role as Lead Account Reimbursement Specialist, you will coordinate the billing and followup process between the organization, payers and patients independently. Additionally, you will analyze and report on insurance denial causes and trends, as well as act as a resource and mentor for peers.
Department Summary :
The Revenue Cycle Central Business Office is located at One Hundred Oaks and has over 200 team members dedicated to the resolution and capture of Accounts Receivable. Key functions of the Business Office include Payer Enrollment, Claims Billing, Insurance Follow-Up, Denial Management and Appeals, Payments, Refunds, Cashiers, and Audits. Team members specialize in complex administrative and technical reimbursement rules associated with producing clean claims and fulfilling regulatory and contracted payer edits along with numerous other billing and/or payment requirements. For more information, please visit https://finance.vumc.org/vmg/revcycle/busofc.aspx .
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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.
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* 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.
Processes claims, payments, adjustments, refunds, denials, and unpaid patient and insurance balances.
Accesses and corrects, if needed, demographic, insurance and financial information.
Serves as a liaison with insurance companies, third party payors, and administrative personnel.
Analyzes incoming financial data to identify, reconcile, and resolve patterns resulting in erroneous or no reimbursement.
Performs account audits in their entirety as well as other complex projects.
Prepares and maintains complex reports and records requiring the identification of sources, compilation, analysis and evaluation of data.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
CODING KNOWLEDGE (INTERMEDIATE): - Ability to assign and interpret ICD-10-CM/PCS coding classification systems and MS-DRG and APR-DRG prospective payment and severity systems.
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.
REVENUE CYCLE (INTERMEDIATE): - Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.
PEER LEADERSHIP (NOVICE): - The ability to show leadership and influence people of equal rank in an effort to accomplish team goals.
Organizational Impact: Independently performs non-routine tasks that significantly impact team and other related teams.
Problem Solving/ Complexity of work: Gathers and analyzes data to solve problems that arise with little or no precedent.
Breadth of Knowledge: Applies advanced job knowledge and has developed a breadth of skills in other areas.
Team Interaction: Serves as a lead for the team by providing expertise and guidance to team members.
Develops Self and Others: Invests time, energy and enthusiasm in developing self/others to help improve performance and gain knowledge in new areas.
Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.
Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.
DELIVERING EXCELLENT SERVICES:
Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.
Solves Complex Problems Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.
Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.
ENSURING HIGH QUALITY:
Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.
Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.
Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.
MANAGING RESOURCES EFFECTIVELY:
Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.
Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.
Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities.
Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.
Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges
Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.
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.