Financial Clearance Specialist Requisition Number 2001473
The Financial Clearance Specialist position services two areas within the Vanderbilt Bill Wilkerson Center—Pi Beta Phi Rehabilitation Institute (PBPRI) and Acute Care Speech-Language Pathology section (Acute SLP). In both practice areas, the role of the Financial Clearance Specialist is to manage the insurance process for patients referred for services in each program. These responsibilities include contacting the insurance company for each patient and determining coverage for the variety of services provided, including identifying policy restrictions or exclusions related to the services provided in each practice area. The Financial Clearance Specialist communicates insurance information to the Associate Access Specialists and the Assistant Manager so that the scheduling process may proceed. When there are issues with insurance coverage, the Financial Clearance Specialist communicates with the patient and his or her family to discuss the policy limitations. The Financial Clearance Specialist also manages the re-authorization process, which requires submitting the appropriate documentation and frequent follow-up calls to the insurance company, to ensure that patient care is not interrupted. The Financial Clearance Specialist consults with the manager and assistant manager, as well as the patient, when billing issues arise.
- High School Diploma or GED
- 2 years of relevant experience
- Obtains certification from insurance companies for all office visits.
- Verifies insurance information and registers cases in tracking system.
- Evaluates patient assets and liabilities to determine ability to pay.
- Reviews alternatives to admission and guides patient in applying for financial assistance.
- Completes pre-certification, credit applications, and other necessary paperwork.
- Performs investigative and follow-up work relating to reimbursement issues.
- The responsibilities listed are a general overview of the position and additional duties may be assigned.
INSURANCE REGULATORY KNOWLEDGE: 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: 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: The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.
PROBLEM SOLVING: 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.
- 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.
- 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 tosupervisors 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.
- Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond.
- 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.
- 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 change by keeping an open mind to changing plans and incorporates change instructions into own area of work.
The Pi Beta Phi Rehabilitation Institute (PBRI) expands the traditional services of the Vanderbilt Bill Wilkerson Center by providing comprehensive neuro-rehabilitation services including:
· Occupational Therapy
· Physical Therapy
· Speech-Language Pathology
· Social Work
The Institute serves as the neurological outpatient rehabilitation center for adolescents and adults at Vanderbilt Medical Center. Common neurological diagnoses treated include traumatic brain injury, stroke, Parkinson's disease, multiple sclerosis, brain tumors and balance disorders. An individualized, structured program is designed for each patient with a goal of maximizing independence in physical, cognitive and emotional functioning.
Our therapists work together as a team to ensure they are addressing issues with physical, cognitive, and emotional functioning, as well as communication, visual perception and daily living. Because the goals of each phase of the rehabilitation process differ, each outpatient therapy program may emphasize different therapies and different levels or aspects of functioning. For more information, please visit:
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· Magnet Recognition Program: Vanderbilt nurses are the only group honored in Middle Tennessee
· Nashville Business Journal: Middle Tennessee's healthiest employer
· American Hospital Association:among the 100 "Most Wired" medical systems in the US
Physical Requirements/Strengths needed & Physical Demands:
- Sedentary category requiring exertion up to 10 lbs. of force occasionally and uses negligible amounts of force to move objects. Sedentary work involves sitting most of the time.
- Occasional: Standing: Remaining on one's feet without moving.
- Occasional: Walking: Moving about on foot.
- Occasional: Lifting under 35 lbs: Raising and lowering objects under 35 lbs from one level to another
- Occasional: Carrying under 35 lbs: Transporting an object holding in hands, arms or shoulders, with help of coworkers or assistive device.
- Occasional: Push/Pull: Exerting force to move objects away from or toward.
- Occasional: Bending/Stooping: Trunk bending downward and forward by bending spine at waist requiring full use of lower extremities and back muscles
- Occasional: Reaching above shoulders: Extending arms in any direction above shoulders.
- Occasional: Reaching below shoulders: Extending arms in any direction below shoulders.
- Occasional: Handling: Seizing, holding, grasping, turning or otherwise working with hand or hands.
- Occasional: Bimanual Dexterity: Requiring the use of both hands.
- Frequent: Sitting: Remaining in seated position
- Frequent: Fingering: Picking, pinching, gripping, working primarily with fingers requiring fine manipulation.
- Continuous: Communication: Expressing or exchanging written/verbal/electronic information.
- Continuous: Auditory: Perceiving the variances of sounds, tones and pitches and able to focus on single source of auditory information
- Continuous: Vision: Clarity of near vision at 20 inches or less and far vision at 20 feet or more with depth perception, peripheral vision, color vision.
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