Lead Payor Enrollment Specialist in Nashville, Tennessee

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:

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 lead for the team by providing expertise and guidance to team members.

Core Capabilities :

Supporting Colleagues: – Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas. – Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships. – Communicates Effectively: Recognizes group interactions and modifies one’s own communication style to suit different situations and audiences. Delivering Excellent Services : – Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them. – Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions. – Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees’ effectiveness. Ensuring High Quality : – Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly. – Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. – Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively : – Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure. – Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area. – Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation: – Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches. – Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges. – Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

5 years

Education:

Bachelor’s

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 to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled