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, DRG, ICD-9, APC), 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.
Key Functions and Expected Performances:
Coordinates the Vanderbilt billing process
Accurately, efficiently and timely processing of claims, payments, refunds, denials, unpaid patient and insurance balances
Must meet productivity standards specific to the work unit guidelines
Accesses and takes corrective action, if necessary, of incoming financial data
Works account referred for follow-up in an accurate and timely manner
Gives feedback to requesting party in a timely manner
Provides accurate account maintenance and documentation sufficient for audit controls
Maintains appropriate batching of financial transactions for imaging and audit purposes.
Account documentations are timely and contain complete information
Serves as liaison with insurance companies, third party payors, and administrative personnel, including Contracts Administration and customers
All necessary entities contacted to bring resolution to matter.
Appropriately contacts proper entities with issues concerning their areas.
Properly alert all areas affected by a particular situation
Analyze incoming financial data to identify patterns from insurance carriers and/or other entities resulting in erroneous or no reimbursement
Entire account audit performed
Payer pattern(s) identified and addressed with payer
Resolution of any issue(s) resulting in delayed or erroneous reimbursement
Obtained proper payer reimbursement
Identification of improper CPT 4/ICD 9 usage (APC, DRG) resulting in denial or erroneous reimbursement
Recognizes coding errors
Has basic coding knowledge
Utilizes coding software package
Ability to identify improper coding linkage errors
Ability to identify improper use of or needed modifiers
Vanderbilt University Medical Center is a comprehensive health care facility dedicated to patient care, research, and biomedical education. Our reputation for excellence in these areas has made us a major center for patient referrals from throughout the Mid-South. Each year, people throughout Tennessee and the Southeast choose Vanderbilt University Medical Center for their health care because of o...ur leadership in medical science and our dedication to treating patients with dignity and compassion.The mission of Vanderbilt University Medical Center is to advance health and wellness through preeminent programs in patient care, education, and research.