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 diverse 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 recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and where your diversity of culture, thinking, learning, and leading 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: VIP MS - Revenue Cycle
Job Summary:
The Account Reimbursement Specialist is knowledgeable with payer policy and procedures and use of websites, the proven ability to recognize, research and report or follow appropriate corrective action plans on trends related to patient account inquiries and payer denials. Disputes and takes ownership by processing appeals for denials or underpayments, knowledgeable with codes (CPT, ICD-10, HCPCS), interactive with patients, departments, or outside entities, ability to research medical necessity denials and knowledge of expected reimbursement. Makes good decisions based on policy, procedures, contracts, and appropriateness of action. The Account Reimbursement Specialist responds to patient questions regarding bills. Facilitates efficient workflow, supports appropriate use of technology, and fosters effective communication to support the company's mission and credo.
KEY RESPONSIBILITIES:
- Accurately, efficiently, and timely processing of claims, refunds, denials, unpaid patient and insurance balances.
- Send electronic files to the clearing house. Print and distribute paper claims.
- Reconcile claims and verify which were accepted or rejected by the payor.
- Determine if claims denials are valid.
- Work with clearinghouse to resolve errors when edits are not valid.
- Make recommendations to management for changes in procedure to prevent future claims errors.
- Respond to problems in person or by telephone in a courteous manner.
- Respond to questions regarding account balances.
- Interpret information from account history and provide detailed explanation to patients of charges, payments, and adjustments.
- Verify, correct and update all demographic and insurance carrier information on patient accounts in computer billing system.
- Work accounts referred for follow-up in an accurate and timely manner.
- Give feedback to requesting party in a timely manner.
- Perform account audit to ensure overall accuracy of information.
- Use medical records to verify charges and service procedures.
- Payer pattern(s) identified and addressed with payer.
- Resolution of any issue(s) resulting in delayed or erroneous reimbursement.
- Recognizes coding errors.
- Ability to identify improper coding linkage errors.
- Ability to identify improper use of or needed modifiers.
- Prepare refund requests.
- Prepare demand statements.
- When patient is unable to pay account in full, establish payment arrangements which follow payment guidelines and methods.
- When patient is unable to commit to payment arrangements within acceptable guidelines, request a financial disclosure statement. Upon receipt, evaluate patient/guarantor assets and liabilities to determine ability to pay.
- Maintains appropriate batching of financial transactions for imaging and audit purposes.
- Account documentation are timely and contain complete information.
- Prepare correspondence to patient or other parties to gather or provide information requested by patients.
- Identify erroneous reimbursement and adjustments according to fee schedule.
- Address expected reimbursement guidelines to carrier, seeking further payment when necessary.
- Contact patients/families/representatives to provide information and support to resolve billing issues.
- Can correctly identify payers with whom Vanderbilt is contracted.
- Uses telephone and computers to facilitate the flow of communication throughout the office.
- Learns and applies new technical skills and systems as technology changes.
- Works with management to identify learning needs surrounding computer and technical systems.
- Follows computer downtime procedures.
- Regular and reliable attendance is required for this position.
- Floats to multiple clinics as needed.
- May be moved mid-shift occasionally.
- All other duties as assigned.
TECHNICAL CAPABILITIES:
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 tasks that are typically routine that may impact team's performance with occasional guidance.
- Problem Solving/ Complexity of work: Utilizes some discretion and research to solve routine problems.
- Breadth of Knowledge: Applies knowledge of standards, established processes and procedure that apply to your own job.
- Team Interaction: Provides guidance to entry level co-workers.
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.
- 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:
2 years
Education:
High School Diploma or GED
Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled
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