Coordinates and assists in the enrollment, maintenance, revalidation, and submission of data/documents for providers and locations for them to successfully submit claims for payment.
Assures enrollment with outside affiliates by coordinating data and document collection and by compiling or requesting reports as needed.
Manages the maintenance of provider records and documents, payor applications, enrollments, and follow-up with payors.
Assesses and verifies data with insurance payors. Coordinates changes/corrections to provider records and provides complete and accurate information for audits.
The responsibilities listed above are a general overview of the position, and additional duties may be assigned as needed.
TECHNICAL CAPABILITIES
Revenue Cycle Software (Intermediate) This position will require revenue cycle knowledge and the use of the practice management software to follow-up on denied and rejected claims for payor enrollment denials and rejections for both Hospital Billing and Professional Billing.
Discretion & Privacy (Intermediate): Using and keeping information confidential in a secure setting is paramount.
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, and responsive to customer needs.
Communication (Intermediate): Effectively, and respectfully communicate to employees, providers, or customers.
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.
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 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.
Core Capabilities :
Supporting Colleagues : Develops Self and Others: Continuously improves own skills by identifying development opportunities.- Builds and Maintains Relationsh
Benefits
Health insurance
Additional Information
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
A payor enrollment specialist is responsible for tracking the process of enrolling healthcare providers with insurance payors or health plans. This typically involves completing and submitting applications, verifying credentials, ensuring compliance with payor requirements, and maintaining accurate records. They may also handle provider updates, changes, and renewals with payors and resolve any issues that arise during the enrollment process. Additionally, they may communicate directly with providers and payors to facilitate smooth enrollment and billing processes.
.
Vanderbilt University Medical Center · Nashville, TN