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 â of culture, thinking, learning and leading â 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. Vanderbiltâs mission is to advance health and wellness through preeminent programs in patient care, education, and research.
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
- Identify payers with/without contracts; interpret payer fee schedule on expected reimbursement
- Can correctly identify payers with whom Vanderbilt is contracted
- Identify erroneous reimbursement and adjustments according to fee schedule
- Address expected reimbursement guidelines to carrier, seeking further payment.
- Differential between payer edit errors and account specific payment error