Maintain high level of knowledge and accuracy of information to ensure optimum reimbursement to VUMC. Assist in financial problem resolution relating to patient care charges. Ensure compliance with hospital collection policies and maintain stringent collection procedure and contract agreements. Appropriate screening of patients for referral to state/other funding resources.
Key Functions and Expected Performances:
Register cases (inpatient and outpatient) in computerized patient tracking system with correct demographics
Effectively utilize complex insurance plan coding system
Ensure demographic information in patient information system is updated and accurate as measured by documented errors
Verifies insurance information
Verifies insurance information including policy and group numbers
Ensures insurance information in patient information system is updated and accurate as measured by documented errors
Ensures appropriate personnel are notified when an insurance change is received.
Evaluate patient/guarantor assets and liabilities to determine ability to pay
May work directly with patient/guarantor and supervisor to work out satisfactory payment plans.
Approve some credit arrangements with guidance of supervisor
Obtain necessary patient or guarantor signatures
In cases of serious financial difficulties, with direction of supervisor, review alternatives to admission with physician and referring hospital (i.e., delay admissions, utilize outpatient services, shorten length of stay, treatment at another facility); if appropriate, guide patient in applying for financial assistance.
Communicate changes in credit and collection policies/procedures to admitting/emergency registration staff; interpret regulations pertaining to collection.
Ensure patient reimbursement meets department protocol, when elective
80% verifiable reimbursement requirement is met
Pre-certification, credit applications, and other necessary paperwork are completed forward to other financial assistance resources
Maintain up to date knowledge of VUMC contracts via MCIS (on-line contracting info) and refer for negotiation any out of network patient.
Ensure all unusual cases are reported appropriately to supervisor
Document and report discrepancies and exceptions
Maintain confidential logs of exceptions and general problems pertaining to patient finance for future reference.
Escalate to manager any high-risk patient cases.
Perform extensive investigative and follow-up work relating to reimbursement issues
Provide other administrative support to the Department
Provide parking validation according to department protocol
Provide technical support to other financial evaluators
Serve as resource to other financial evaluators in matters relating to financial counseling and policy interpretation
Vanderbilt University Medical Center is a comprehensive health care facility dedicated to patient care, research, and biomedical education. Our reputation for excellence in these areas has made us a major center for patient referrals from throughout the Mid-South. Each year, people throughout Tennessee and the Southeast choose Vanderbilt University Medical Center for their health care because of o...ur leadership in medical science and our dedication to treating patients with dignity and compassion.The mission of Vanderbilt University Medical Center is to advance health and wellness through preeminent programs in patient care, education, and research.
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The mission of the University Risk Management and Insurance Association is to advance the discipline of risk management
in higher education.