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Vanderbilt University Medical Center Lead Acct Reimbursement Spec in Des Moines, Iowa

Lead Acct Reimbursement Spec - 2201746

Job : Medical Coding and Billing

Primary Location : Work from Home

Organization : Coding and Auth. Appeals 108451

Shift: : First Shift

Description

Lead Account Reimbursement Specialist - Specialty Billing, One Hundred Oaks

JOB SUMMARY:

In your pivotal role as Lead Account Reimbursement Specialist, you will coordinate the billing and followup process between the organization, payers and patients independently. Additionally, you will analyze and report on insurance denial causes and trends, as well as act as a resource and mentor for peers.

Department Summary :

The Revenue Cycle Central Business Office is located at One Hundred Oaks and has over 200 team members dedicated to the resolution and capture of Accounts Receivable. Key functions of the Business Office include Payer Enrollment, Claims Billing, Insurance Follow-Up, Denial Management and Appeals, Payments, Refunds, Cashiers, and Audits. Team members specialize in complex administrative and technical reimbursement rules associated with producing clean claims and fulfilling regulatory and contracted payer edits along with numerous other billing and/or payment requirements. For more information, please visit https://finance.vumc.org/vmg/revcycle/busofc.aspx .

Position Shift:

Monday-Friday, 7:30AM-4:00PM

View how Vanderbilt Health employees celebrate the difference they make every day:

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 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. It is a place 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.

VUMC Recent Accomplishments

Because we are committed to providing the best in patient care, education and research, we are proud of our recent accomplishments:

  • US News & World Report: #1 Adult Hospital in Tennessee and metropolitan Nashville, named to the Best Hospitals Honor Roll of the top 20 adult hospitals, 10 nationally ranked adult specialty programs, with 3 specialties rated in the top 10 nationally, Monroe Carell Jr. Children’s Hospital at Vanderbilt named as one of the Best Children’s Hospital in the nation, with 10 out of 10 pediatric specialties nationally ranked.

  • Healthcare’s Most Wired: Among the nation’s 100 “most-wired” hospitals and health systems for its efforts in innovative medical technology.

  • Becker’s Hospital Review: named as one of the “100 Great Hospitals in America”, in the roster of 100 Hospitals and Health Systems with Great Oncology Programs and to its list of the 100 Hospitals with Great Heart Programs.

  • The Leapfrog Group: One of only 10 children’s hospitals in the to be named at Leapfrog Top Hospital.

  • American Association for the Advancement of Science: The School of Medicine has 112 elected fellows

  • Magnet Recognition Program: Received our third consecutive Magnet designations.

  • National Academy of Medicine: 22 members, elected by their peers in recognition of outstanding achievement

  • Human Rights Campaign Healthcare Equality Index: 6 th year in a row that Vanderbilt University Medical Center was a Leader in LGBTQ Healthcare Equality.

KEY 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.

  • The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES:

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.

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.

REVENUE CYCLE (INTERMEDIATE): - Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.

PEER LEADERSHIP (NOVICE): - The ability to show leadership and influence people of equal rank in an effort to accomplish team goals.

CORE ACCOUNTABILITIES:

  • Organizational Impact: Independently performs non-routine tasks that significantly impact team and other related teams.

  • Problem Solving/ Complexity of work: Gathers and analyzes data to solve problems that arise with little or no precedent.

  • Breadth of Knowledge: Applies advanced job knowledge and has developed a breadth of skills in other areas.

  • Team Interaction: Serves as a lead for the team by providing expertise and guidance to team members.

CORE CAPABILITIES:

SUPPORTING COLLEAGUES:

  • 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.

DELIVERING EXCELLENT SERVICES:

  • 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.

ENSURING HIGH QUALITY:

  • 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.

MANAGING RESOURCES EFFECTIVELY:

  • 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.

FOSTERING INNOVATION:

  • 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.

Qualifications - External

QUALIFICATIONS:

  • High School Diploma or GED

  • 5 years relevant experience

Physical Requirements/Strengths needed & Physical Demands:

  • Sedentary category requiring exertion up to 10 lbs. of force occasionally and uses negligible amounts of force to move objects. Sedentary work involves sitting most of the time. Movement

  • Occasional: Standing: Remaining on one's feet without moving.

  • Occasional: Walking: Moving about on foot.

  • Occasional: Lifting under 35 lbs: Raising and lowering objects under 35 lbs from one level to another

  • Occasional: Carrying under 35 lbs: Transporting an object holding in hands, arms or shoulders, with help of coworkers or assistive device.

  • Occasional: Push/Pull: Exerting force to move objects away from or toward.

  • Occasional: Bending/Stooping: Trunk bending downward and forward by bending spine at waist requiring full use of lower extremities and back muscles

  • Occasional: Reaching above shoulders: Extending arms in any direction above shoulders.

  • Occasional: Reaching below shoulders: Extending arms in any direction below shoulders.

  • Occasional: Handling: Seizing, holding, grasping, turning or otherwise working with hand or hands.

  • Occasional: Bimanual Dexterity: Requiring the use of both hands.

  • Frequent: Sitting: Remaining in seated position

  • Frequent: Fingering: Picking, pinching, gripping, working primarily with fingers requiring fine manipulation. Sensory

  • Continuous: Communication: Expressing or exchanging written/verbal/electronic information.

  • Continuous: Auditory: Perceiving the variances of sounds, tones and pitches and able to focus on single source of auditory information

  • Continuous: Vision: Clarity of near vision at 20 inches or less and far vision at 20 feet or more with depth perception, peripheral vision, color vision.

License Required 1

No Licensure or Certification Required.

Basic Qualifications

High School Diploma or GED (or equivalent experience) and 5 years relevant experience

Licensure, Certification, and/or Registration (LCR):

Physical Requirements/Strengths needed & Physical Demands:

  • Sedentary category requiring exertion up to 10 lbs. of force occasionally and uses negligible amounts of force to move objects. Sedentary work involves sitting most of the time.

Movement

  • Occasional: Standing: Remaining on one's feet without moving.

  • Occasional: Walking: Moving about on foot.

  • Occasional: Lifting under 35 lbs: Raising and lowering objects under 35 lbs from one level to another

  • Occasional: Carrying under 35 lbs: Transporting an object holding in hands, arms or shoulders, with help of coworkers or assistive device.

  • Occasional: Push/Pull: Exerting force to move objects away from or toward.

  • Occasional: Bending/Stooping: Trunk bending downward and forward by bending spine at waist requiring full use of lower extremities and back muscles

  • Occasional: Reaching above shoulders: Extending arms in any direction above shoulders.

  • Occasional: Reaching below shoulders: Extending arms in any direction below shoulders.

  • Occasional: Handling: Seizing, holding, grasping, turning or otherwise working with hand or hands.

  • Occasional: Bimanual Dexterity: Requiring the use of both hands.

  • Frequent: Sitting: Remaining in seated position

  • Frequent: Fingering: Picking, pinching, gripping, working primarily with fingers requiring fine manipulation.

Sensory

  • Continuous: Communication: Expressing or exchanging written/verbal/electronic information.

  • Continuous: Auditory: Perceiving the variances of sounds, tones and pitches and able to focus on single source of auditory information

  • Continuous: Vision: Clarity of near vision at 20 inches or less and far vision at 20 feet or more with depth perception, peripheral vision, color vision.

Environmental Conditions

Req ID: 2201746

Vanderbilt University Medical Center is committed to principles of equal opportunity and affirmative action.

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