Senior Financial Clearance Specialist (Plastics and Cosmetic Surgery) - HYBRID

Vanderbilt University Medical Center•Nashville, TN

5d•Hybrid

About The Position

Performs and documents pre-certification from insurance companies for all elective surgeries and visits, with minimal guidance. This role is part of the Plastics & Cosmetic Surgery Administration team at Vanderbilt University Medical Center (VUMC), a leading institution in patient care, education, and research. VUMC is committed to fostering an environment where everyone can thrive and where uniqueness is celebrated. The organization aims to advance health and wellness through its preeminent programs.

Requirements

Relevant Work Experience
4 years of experience
High School Diploma or GED
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.

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