JOB SUMMARY: Enrolls providers into various insurance payers systems with occasional guidance. Coordinates and assists in collection, processing, dissemination and submission of data and documentation for providers or other payers.
Coordinates and assists in the enrollment, re-enrollment, re-validation and submission of data/documents for providers and locations in order for them to submit claims for payment.
Assures enrollment with outside affiliates by coordinating data/document collection and by compiling or requesting reports as needed.
Manages maintenance of provider records and documents, payer applications, enrollments and follow up to payers.
Assesses and verifies data with insurance payers. Coordinates changes/corrections to provider records and provides complete and accurate information for audits.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
PROBLEM SOLVING (NOVICE): - 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.
REGULATORY AWARENESS (NOVICE): - Demonstrates knowledge of healthcare regulations and security best practices. Identifies appropriate sources of governmental and industry guidance. Interprets regulations and guidance to assist application and business stakeholders with compliance and security best practice efforts.
COMMUNICATION (NOVICE): - Clearly, effectively and respectfully communicates to employees or customers.
CUSTOMER SERVICE (NOVICE): - 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.
DISCRETION & PRIVACY (NOVICE): - The ability to use and keep information confidential in a secure setting.
INSURANCE REGULATORY KNOWLEDGE (NOVICE): - 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.
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.
SUPPORTING COLLEAGUES (S2):
- 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 (S2):
- 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 tosupervisors in a timely manner.
- Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support.
ENSURING HIGH QUALITY (S2):
- 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.
MANAGING RESOURCES EFFECTIVELY (S2):
- 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 (S2):
- 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 change by keeping an open mind to changing plans and incorporates change instructions into own area of work.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.