Lead Payor Enrollment Specialist

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. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness 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. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research.

Organization:

Payor/Provider Enrollment

Job Summary:

JOB SUMMARY
Enrolls providers into various insurance payers system independently. Focuses on documentation requirements of compliance processes associated with external regulatory agencies. Stays informed of requirements as defined by regulatory agencies and published regulations. Coordinates and assists in collection, processing, dissemination and submission of data, documentation, and reports for providers or other payers.

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KEY RESPONSIBILITIES

• 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.
• Collaborates with committees, departments, and interdisciplinary teams to define requirements and understand processes and work flow in order to comply with documentation requirements.
• Serves as a resource for regulatory interpretation and application to required documentation.
• Facilitates preparation and organization response to external audits and agency reviews.
• Collects, documents, and maintains required data to ensure compliance with regulatory requirements. Conduct quality review of data to ensure integrity of data.
• Identify gaps and non-compliant items and ensure timely communication to leaders. Maintains processes for follow up to ensure closure of outstanding items.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES

• Regulatory Awareness (Advanced): 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.
• Problem Solving (Advanced): 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.
• Communication (Advanced): Clearly, effectively and respectfully communicates to employees or customers.
• Customer Service (Advanced): 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 (Intermediate): The ability to use and keep information confidential in a secure setting.
• Insurance Regulatory Knowledge (Intermediate): 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.

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

* Organizational Impact: Independently performs non-routine tasks that significantly impact team and other related teams.* Problem Solving/ Complexity of work: Gathers and analyzes data to solve problems that arise with little or no precendent.* Breadth of Knowledge: Applies advanced job knowledge and has developed a breadth of skills in other areas. * Team Interaction: Serves as a