Vanderbilt University Medical Center Sr. Account Reimbursement Specialist - Denials Auth & Appeals in Nashville, Tennessee

JOB SUMMARY:

Coordinates the billing and followup process between the organization, payers and patients with minimal guidance. Recognizes, researches, reconciles, and reports appropriate corrective action plans on trends related to patient account inquiries and payer denials.

KEY RESPONSIBILITIES:

  • Processes claims, payments, adjustments, refunds, denials, and unpaid patient and insurance balances.

  • Accesses and corrects, if needed, demographic, insurance and financial information.

  • Provides accurate account maintenance and documentation.

  • Serves as a liaison with insurance companies, third party payors, and administrative personnel.

  • Analyzes incoming financial data to identify, reconcile, and resolve patterns resulting in erroneous or no reimbursement.

  • The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES:

CODING KNOWLEDGE (NOVICE): - Ability to assign and interpret ICD-10-CM/PCS coding classification systems and MS-DRG and APR-DRG prospective payment and severity systems.

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.

REVENUE CYCLE (NOVICE): - Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.

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: Applies broad job knowledge and has basic job skills in other areas.

  • Team Interaction: Provides informal guidance and support to less experienced team members.

High School Diploma or GED (or equivalent experience) and 4 years relevant experience

Licensure, Certification, and/or Registration (LCR):

Job Medical Coding and Billing

Organization: Coding and Auth. Appeals 10 108451

Title: Sr. Account Reimbursement Specialist - Denials Auth & Appeals

Location: TN-Nashville-Vanderbilt Health One Hundred Oaks (OHO)

Requisition ID: 1803743

Vanderbilt University Medical Center is committed to principles of equal opportunity and affirmative action.