Lead Account Reimbursement Specialist (Self-pay Follow Up / Quality Assurance)

Vanderbilt University Medical Center•Nashville, TN

1d•Onsite

About The Position

Vanderbilt University Medical Center (VUMC) is seeking a Lead Account Reimbursement Specialist to coordinate the billing and follow-up process between the organization, payers, and patients. This role involves analyzing and reporting on insurance denial causes and trends, and acting as a resource and mentor for peers. VUMC is a community dedicated to advancing health and wellness through patient care, education, and research, fostering an environment where expertise is valued and growth is encouraged.

Requirements

5 years of relevant work experience
High School Diploma or GED
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.
Peer Leadership (Novice): The ability to show leadership and influence people of equal rank in an effort to accomplish team goals.
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.
Revenue Cycle (Intermediate): Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.

Nice To Haves

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.
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.
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.
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.

Responsibilities

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.