Senior Financial Clearance Specialist, Wound Center - ONSITE

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. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness 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.

Organization:

Surgery PCC Admin

Job Summary:

Performs and documents pre-certification from insurance companies for all elective surgeries and visits, with minimal guidance.

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KEY RESPONSIBILITIES

• 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.
• Performs tasks to support and obtains pre-certifications from insurance companies

TECHNICAL CAPABILITIES

• 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.

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

* 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.

Core Capabilities :

Supporting Colleagues: - 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: - 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 in a timely manner. - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality: - 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: - 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: - 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 changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

4 years

Education:

High School Diploma or GED

This role offers the opportunity to make a meaningful impact within Vanderbilt Health, supported by a comprehensive benefits package which may include health, disability, retirement and/or wellness offerings to enhance your well-being and professional growth.

Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.