JOB SUMMARY: Validates billed charges and negotiates with third party auditor to reconcile bills, independently.
Negotiates with third party auditors.
Reviews medical records and billing information. Interprets clinical information to resolve issues.
Audits complex accounts and reviews to implement or recommend appropriate action to correct the issue.
Recognizes payer specific rules and identifies possible issues and specific trends.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
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.
REVENUE CYCLE (INTERMEDIATE):- Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.
PROBLEM SOLVING (INTERMEDIATE):- 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.
CLINICAL KNOWLEDGE (ADVANCED):- Knowledge of patient care including patient assessment and treatment, care planning, patient education and evidence based practice. Understanding of medical terminology and documentation.
Organizational Impact: Independently delivers on objectives with understanding of how they impact the results of own area/team and other related teams.
Problem Solving/ Complexity of work: Utilizes multiple sources of data to analyze and resolve complex problems; may take a new perspective on existing solution.
Breadth of Knowledge: Has advanced knowledge within a professional area and basic knowledge across related areas.
Team Interaction: Acts as a go-to resource for colleagues with less experience; may lead small project teams.
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.