Senior Financial Clearance Specialist (Prior Insurance Authorization exp required; V.A. exp preferred) - ONSITE

Vanderbilt University Medical Center•Nashville, TN

3d•Onsite

About The Position

Performs and documents pre-certification from insurance companies for all elective surgeries and visits, with minimal guidance. This role is crucial for obtaining certification from insurance companies for all elective out-patient specialty surgeries for both the surgeon and the facility. It involves contacting insurance review agencies to request authorization, handling problematic certification cases with relevant internal groups, and performing investigative and follow-up work on cases with pre-certification issues until the issue is resolved. The specialist will document the certification process in the appropriate applications to facilitate accurate concurrent review, billing, and reimbursement, and coordinate 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.

Requirements

Prior Insurance Authorization experience required.
Relevant Work Experience: 4 years
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.

Nice To Haves

V.A. experience preferred.

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.