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

Vanderbilt University Medical Center•Nashville, TN

3d•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) in Nashville, Tennessee. VUMC is a leading institution in patient care, education, and research, committed to an environment where everyone can thrive and their 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.

Nice To Haves

Performs non-routine tasks that significantly impact team's performance with minimal guidance.
Conducts research and analysis to solve some non-routine problems.
Applies broad job knowledge and has basic job skills in other areas.
Provides informal guidance and support to less experienced team members.
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.
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.
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.
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.
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.

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.