Senior Financial Insurance Clearance Specialist - Transplant

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 diverse 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 recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and where your diversity of culture, thinking, learning, and leading 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:

Transplant Financial

Job Summary:

JOB SUMMARY
Performs and documents pre-certification from insurance companies for all elective surgeries and visits, with minimal guidance.

A post transplant financial coordinator is needed to support all adult organ transplant programs. Post transplant patients receive regular care at Vanderbilt Health and insurance issues will be handled by the transplant financial coordinator to ensure patients maintain in-network insurance.

Department Summary:
Vanderbilt Health is a leading provider of organ transplantation in the United States, giving hundreds of people new hope and longer life each year. For more than six decades, the Vanderbilt team has been committed to providing lifesaving transplants to people from all over the world. As Tennessee’s only full-service transplant center, we offer the most advanced care for end-stage organ failure in children and adults. Our transplant specialists also perform lifesaving dual-organ transplants, including heart-kidney, heart-liver, heart-lung, kidney-pancreas and liver-kidney.

Hours:
Monday - Friday 8:00 a.m. - 5:00 p.m.

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KEY RESPONSIBILITIES
• Obtains certification from insurance companies for all elective out-patient specialty surgeries for both the surgeon and the facility.
• Contacts insurance review agencies to request authorization.
• Handles problematic certification cases with relevant internal groups.
• Performs investigative and follow-up work on cases with pre-certification issues until the issue is resolved.
• Documents certification process in the appropriate applications to facilitate accurate concurrent review, billing and reimbursement.
• Coordinates co-pays or monies to be collected from the patient.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.
• Performs tasks to support and obtains pre-certifications from insurance companies

TECHNICAL CAPABILITIES
• Insurance Regulatory Knowledge (Advanced): 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.
• Customer Service (Intermediate): 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.
• Data Entry (Intermediate): The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.
• 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.

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: Performs non-routine tasks that significantly impact team's performance with minimal guidance. * Problem Solving/ Complexity of work: Conducts research and analysis to solve some non-routine problems.* Breadth of Knowledge: