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.
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 our 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.