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Payer Enrollment Specialist

2 months ago

Nashville, United States Vanderbilt University Medical Center Full time

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
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.

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KEY RESPONSIBILITIES

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

Regulatory Awareness (Intermediate): 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 (Intermediate): Uses critical thinking and process improvement, i.e., coaches and mentors develop a problem statement, describes the current state, identify root causes, create future state, coaches, and mentors develop solutions and action plans with a sustainability plan. Applies appropriate tools to address issues. 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 Relationships: Seeks to understand colleagues' priorities, working styles and develops relationships across areas.- Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner. Delivering Excellent Services: - Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service.- Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality: - Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards. - Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively : - Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. - Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources. - Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation : - Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action. - Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

2 years

Education:

High School Diploma or GED

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