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.
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. 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
JOB CODE INFORMATION:
Job Code: 6207
Job Stream Description: Support/Technical
JOB SUMMARY: Enrolls providers into various insurance payers system independently. Focuses on documentation requirements of compliance processes associated with external regulatory agencies. Stays informed of requirements as defined by regulatory agencies and published regulations. Coordinates and assists in collection, processing, dissemination and submission of data, documentation, and reports for providers or other payers.
Manages maintenance of provider records and documents, payer applications, enrollments and follow up to payers.
Assesses and verifies data with insurance payers. Coordinates changes/corrections to provider records and provides complete and accurate information for audits.
Collaborates with committees, departments, and interdisciplinary teams to define requirements and understand processes and work flow in order to comply with documentation requirements.
Serves as a resource for regulatory interpretation and application to required documentation.
Facilitates preparation and organization response to external audits and agency reviews.
Collects, documents, and maintains required data to ensure compliance with regulatory requirements. Conduct quality review of data to ensure integrity of data.
Identify gaps and non-compliant items and ensure timely communication to leaders. Maintains processes for follow up to ensure closure of outstanding items.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
PROBLEM SOLVING (ADVANCED): - 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.
REGULATORY AWARENESS (ADVANCED): - Demonstrates knowledge of healthcare regulations and security best practices. Identifies appropriate sources of governmental and industry guidance. Interprets regulations and guidance to assist application and business stakeholders with compliance and security best practice efforts.
COMMUNICATION (ADVANCED): - Clearly, effectively and respectfully communicates to employees or customers.
CUSTOMER SERVICE (ADVANCED): - 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.
DISCRETION & PRIVACY (INTERMEDIATE): - The ability to use and keep information confidential in a secure setting.
INSURANCE REGULATORY KNOWLEDGE (INTERMEDIATE): - 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.
SUPPORTING COLLEAGUES (S4):
- 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 (S4):
- 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 (S4):
- 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 (S4):
- 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.
FOSTERING INNOVATION (S4):
- 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.
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 ), 9 adult and 9 pediatric clinical specialties ranked among the nation's best, #15 Education and Training
Truven Health Analytics: among the top 100 hospitals in the US
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
American Association for the Advancement of Science: 12 faculty members elected fellows in 2014
Magnet Recognition Program: Vanderbilt nurses are the only group honored in Tennessee
Nashville Business Journal: Middle Tennessee's healthiest employer
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 disea...se.
As the 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.