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 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 is committed to an environment where everyone has the chance to thrive and where your uniqueness 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: VHCS Admin - Support Job Summary: Collaborates with the home health care team to coordinate patient home care across the continuum of home care by requesting authorization for patient visits. Serves in an advocacy role on behalf of patients, families, and caregivers to ensure safe, equitable healthcare provision. Assists in developing and meeting key Pillar outcomes and system improvement goals including financial, satisfaction, and clinical as the Home Care Managed Care Coordinator. . ROLE FOCUS This role primarily involves insurance authorizations, coverage verification, and follow-up with payers. PRIMARY DUTIES - Submitting and tracking authorizations. - Communicating with insurance companies. - Verifying coverage and benefits. - Following up on pending authorization approvals. KEY RESPONSIBILITIES • Request authorizations for Home Health Care from insurance carriers, through whatever method is optimal and the most efficient and effective for that carrier. • Obtain Start of Care (SOC) authorization. • Obtain Add-on prior authorization, obtain prior authorization for Resumption of Care (ROC), obtain concurrent authorization. • Enter authorization request responses. • Case Management Advocacy. • Review written off no authorization (wona) requests from billing team for possible. • Confer with other MCC's, brainstorm on any new payer process changes, and update Payer Auth Requirement document • Review and respond to all messages from all staff including concurrent authorization requests/payer questions. • Review and responds timely to all billing company communication through our “Jira” tool and effectively minimizes the outstanding “Jira” messages in their work que. • Review and correct process errors from authorization Edit reports. • Review validation report errors. • Review and respond timely to Outlook messages and voice mail messages and review Outlook calendar reminders. • The responsibilities listed are a general overview of the position and additional duties may be assigned. • Demonstrates leadership skills and acts as the key information and education resource for the interdisciplinary team as related to insurance authorization needs and securing appropriate services. • Integrates ethical provisions in all areas of the practice. • Deep dive analyses of insurance denials and authorization requests, using excel spreadsheet for data tracking. TECHNICAL CAPABILITIES • Data Analytics (Intermediate): Can analyze and interpret data to derive insight. Applies the appropriate approach to provide creative solutions for the given problem. May have working knowledge in business intelligence and analytics software [such as Tableau, Business Objects, Excel, and R]. • Managed Care Coordinators Management (Intermediate): Demonstrates mastery of insurance carrier authorization management in practical applications for Home Care clinical care coordination of visits. Possesses sufficient knowledge, training, and experience to be capable of successfully delivering results without requiring support and instruction from others. Able to train and educate by setting the example, giving instruction, providing leadership, and generally raising the level of performance of others while on the job. • Authorization Evaluation (Intermediate): Possesses sufficient knowledge, training, and experience to role model and coach less experienced peers. • Evidence Based Practice (INTERMEDIATE): Demonstrates ability to integrate evidence from multiple sources and determine if a practice change should occur. Shares knowledge with peers and other clinical team members independently. 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: Executes job responsibilities with the understanding of how output would affect and impact other areas related to own job area/team with occasional guidance. Problem Solving/ Complexity of work: Analyzes moderately complex problems using technical experience and judgment. Breadth of Knowledge: Has expanded knowledge gained through experience within a professional area. Team Interaction: Provides informal guidance and support to team members. Core Capabilities : Supporting Colleagues:- Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas.- Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.- Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Services:- Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.- Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.- Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.- Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.- Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation:- Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.- Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.- Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements. Position Qualifications: Responsibilities: Certifications: Work Experience: Relevant Work Experience Experience Level: 5 years Education: Bachelor's Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.