Discover Vanderbilt Health : With eight hospitals and over 180 clinics, we are the region’s largest comprehensive academic health system. Vanderbilt Health has a long tradition of providing world-class care to the people of the Mid-South, living out our mission of moving medicine forward through preeminent programs in patient care, education and research. Here you’ll find a spirit of collaboration and a supportive community where your expertise is valued, your knowledge expanded and your uniqueness celebrated. We are committed to fostering an environment where talented, compassionate people are united in bringing the most advanced care to our neighbors throughout the region. Organization: PB Billing and Claims Job Summary: Provides leadership in evaluating revenue cycle performance operations. Ensures appropriate reimbursement of professional and technical services for multiple areas. KEY RESPONSIBILITIES: - Performs analysis of charges generated from ancillary subsystems to the insurance claim and/or patient statement to verify the accuracy of charges, and of charges that correlate with documented medical/nursing interventions. - Identifies, verifies, and resolves deficiencies or discrepancies in nursing and/or physician documentation that affects billing and notifies the originator of the incorrect documentation to allow for proactive improvements related to charge capture. - Assists with quality audits. - Demonstrates and applies the various reimbursement methodologies (DRGs and APCs) to secure optimal reimbursement. - Understands the relevance and impact of correct units, modifiers on reimbursement under the various methodologies. - Identifies appropriate charges on the patient bill, utilizing documentation from the medical record. - Collaborates with the clinical department administrators in the development and implementation of educational activities related to charge capture improvement projects. - Coordinates work and communicates and proactively resolves critical charge capture and coding issues to multiple management lines. - Assists with onboarding/training new hires and mentors team members on new concepts, workflow changes, processes where skills need to be enhanced (i.e. Excel functions). - The responsibilities listed above are a general overview of the position and additional duties may be assigned. TECHNICAL CAPABILITIES: - Revenue Cycle (Expert): Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance. - 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. - Process Improvement (Advanced): Identifies, analyzes and improves upon existing business processes for optimization and to meet standards of quality. - Epic Professional Billing Certified in Claims or Billing - 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: Delivers projects/assignments that have a direct impact on goals/objectives of the unit/department that the job is in. - Problem Solving/ Complexity of work: Conducts extensive analysis of situations or data to resolve numerous, complex issues; may involve the input/work of others. - Breadth of Knowledge: Has in-depth level of knowledge within a professional area and working knowledge of other areas. - Team Interaction: May lead mid-sized projects; coaches and guides team members. Core Capabilities: - Supporting Colleagues: - Develops Self and Others: