• 2301076

Sr Financial Clearance Specialist

Surgical Weight Loss Clinic, One Hundred Oaks

Job Summary:

Performs and documents pre-certification from insurance companies for all elective surgeries and visits, with minimal guidance.

Position Shift:

• Monday – Friday 8:00 AM – 5:00 PM

Qualifications:

High School Diploma or GED (or equivalent experience) and 4 years relevant experience

Department Summary:

Welcome to the Vanderbilt Weight Loss Center. The clinic is located at Vanderbilt Health at One Hundred Oaks, 719 Thompson Lane Suite 22000 Nashville, TN 37204. We provide both medical and surgical weight loss for the adult population. We are looking for highly motivated individuals that would like to join a growing clinic.

Our excellent, patient centered care is directed and/or delivered by a collaborative team made up of Attending Physicians, Nurse Practitioners, Dietitians, Psychologists, a Program Coordinator and Licensed Clinical Social Workers. The Leadership Team is comprised of a Medical Director, a Clinic Manager, an Administrative Manager, and an Administrative Assistant. Clinic staff members include Registered Nurses, Licensed Practical Nurses, Medical Assistants, and Patient Services Representatives and Financial Clearance Specialist.

We are committed to providing excellent service to our patients and a supportive and caring work environment for our staff.

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.

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

VUMC Recent Accomplishments

Because we are committed to providing the best in patient care, education and research, we are proud of our recent accomplishments:

• US News & World Report: #1 Adult Hospital in Tennessee and metropolitan Nashville, named to the Best Hospitals Honor Roll of the top 20 adult hospitals, 10 nationally ranked adult specialty programs, with 3 specialties rated in the top 10 nationally, Monroe Carell Jr. Children’s Hospital at Vanderbilt named as one of the Best Children’s Hospital in the nation, with 10 out of 10 pediatric specialties nationally ranked.
• Healthcare’s Most Wired: Among the nation’s 100 “most-wired” hospitals and health systems for its efforts in innovative medical technology.
• Becker’s Hospital Review: named as one of the “100 Great Hospitals in America”, in the roster of 100 Hospitals and Health Systems with Great Oncology Programs and to its list of the 100 Hospitals with Great Heart Programs.
• The Leapfrog Group: One of only 10 children’s hospitals in the to be named at Leapfrog Top Hospital.
• American Association for the Advancement of Science: The School of Medicine has 112 elected fellows.
• Magnet Recognition Program: Received our third consecutive Magnet designations.
• National Academy of Medicine: 22 members, elected by their peers in recognition of outstanding achievement.
• Human Rights Campaign Healthcare Equality Index: 6th year in a row that Vanderbilt University Medical Center was a Leader in LGBTQ Healthcare Equality.
  

Key Responsibilities:

• Obtains certification from insurance companies for all elective out-patient specialty surgeries for both the surgeon and the facility.
• Contacts insurance review agencies to request authorization.
• Handles problematic certification cases with relevant internal groups.
• Performs investigative and follow-up work on cases with pre-certification issues until the issue is resolved.
• Documents certification process in the appropriate applications to facilitate accurate concurrent review, billing and reimbursement.
• Coordinates co-pays or monies to be collected from the patient.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.
• Performs tasks to support and obtains pre-certifications from insurance companies

High School Diploma or GED (or equivalent experience) and 4 years relevant experience

Licensure, Certification, and/or Registration (LCR):

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.

Movement

• 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.

Sensory

• 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.

Environmental Conditions