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.
Organization:
Regulatory Oversight
Job Summary:
JOB SUMMARY
Assists with the analysis of regulatory requirements pertaining to critical revenue cycle functions to promote compliance with federal and state regulations and organizational policies. Prepares data for inclusion in presentations on strategic requirements to senior leadership related to implementations of systematic and procedural changes to ensure compliant and efficient clinical billing activities. Assists with both internal and external audits of data as required to identify opportunities for corrective action plans related to third-party audits and appeal activities.
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Key Responsibilities
Conducts research on regulatory guidance to identify regulatory requirements and provide proactive compliance monitoring and assessments with regards to key initiatives and increasing compliance requirements for a wide array of healthcare operational and financial matters including revenue cycle processing and reporting.
Assists with the analysis and interpretation of data from internal/external sources to provide information to all levels of leadership.
Participates in the assembly of documentation and data to support analytical reporting to senior business operational leaders and physician leadership regarding:
- Audit results to outside regulators, attorneys, and other stakeholders;
- Documentation requests from the Office of Legal Affairs and Office of Compliance;
- Identification of best practices and control procedures over operations and/or patient care to promote regulatory compliance;
- Assistance in monitoring the workflows/processes in key clinical areas for revenue related control risks; and
- Assistance in the surveillance of documented revenue cycle controls and reporting on areas of deficiencies.
Analyzes and audits regulatory controls over critical revenue cycle processes.
Compiles supporting documentation (workpapers and control questionnaires) to support and defend the medical center’s position in the event of third-party audits and appeals related to disputed issues.
Prepares slides of audit results for inclusion in presentations to unit leaders and executive steering committees.
Key Responsibilities (Cont’d.)
Reviews and provides input on policy drafts and revisions specific to revenue cycle processes as needed.
Interfaces and maintains appropriate service with customers including Office of Compliance, Health IT, Revenue Cycle, and other physician and hospital management teams on regulatory changes, approval requirements, and audit results.
Monitors new regulatory and/or billing requirement changes from Medicare Administrative Carriers and CMS websites and published guidance.
Performs other special projects as assigned.
Technical Capabilities
Project Management (Intermediate) – Assist in the planning and organizing data for review by unit leaders and executive steering committees to promote compliant actions regarding regulatory guidance and audits.
Regulatory Compliance (Intermediate) – Demonstrates solid knowledge of federal and state regulations in a complex business environment pertaining to patient charging and billing practices, patient access services, chargemaster management, payer contracting, and claims presentation.
Regulatory Documentation (Intermediate) – Writes clear, concise and comprehensive documentation, such as summarized audit findings that may include financial analysis/trending impacts and system and operational improvement action plans. Incorporates data into formal presentations to provide guidance and supporting documentation for review by Office of Compliance, Office of Legal Affairs, and Executive leadership teams.
Regulatory Strategy (Intermediate) – Demonstrates ability to successfully analyze and present critical information pertaining to CMS and state regulatory requirements to proactively implement systematic and policy changes. Identifies relevant stakeholders to obtain critical information for decision making and interacts with executive leaders to formalize compliant strategies.
Healthcare Data Analysis (Advanced) – Navigates within established technology environments to locate, validate, extract and format data for analysis. Able to modify and run queries and standard reports from data tools and provide critical information to unit leaders. Strong skills in data analysis and ability to break down problems into simple components and make sound decisions. Ability to contribute innovative thinking and new ideas/solutions in a multi-disciplinary team environment.
Core Accountabilities
Supporting Colleagues
- Develops Self and Others – Invests time, energy and enthusiasm in developing self/others to help improve performance 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 an opportunity for improvement; actively embraces change instead of emphasizing negative elements.
Basic Qualifications
Degree
Associate’s Degree and/or Bachelor’s Degree (Required)
Associate’s and/or Bachelor’s degree can be substituted by relevant experience and/or relevant clinical licensure.
Master’s Degree (Preferred)
Professional Experience
8 Years’ Experience in Revenue Cycle, Consulting or Auditing in a Large Healthcare Environment, hospital, physician practice, third party payer, Medicare intermediary, health insurer, or accounting/consulting firm. (Required)
10 Years’ Experience as a healthcare industry expert with a consulting firm or in a compliance office role with a large academic medical center (Preferred)
Skills (All Required)
Experience with patient care level data analysis and reporting
Experience with formal presentations to senior operational executives and physician leadership
Experience with business intelligence tools
Intermediate to expert knowledge of various processes associated with revenue cycle in a complex business environment.
Intermediate to expert knowledge with Microsoft Office programs (specifically Visio, Excel and PowerPoint)
Solid working knowledge of hospital and professional EHR systems
Self-Starter with innate ability to gather relevant information systematically and summarize problems into simple components and make sound recommendations
Ability to contribute innovative thinking and new ideas/solutions in a multidisciplinary team environment
Skills (Preferred)
Experience working in EPIC EHR systems and associated tools
Experience with Business Objects for data retrieval and manipulation
Knowledge of Third-Party Contracting Strategies
Knowledge of Chargemaster Management and Pricing Strategies
Knowledge of CMS and state regulations impacting charging and reimbursement
Knowledge of ICD CM and AMA Coding
Excellent presentation and communication skills
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: 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 Service: - 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 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
