Registration/Referral Specialist

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:

VEI - Franklin

Job Summary:

JOB SUMMARY
Verify patient insurance eligibility with payers. Obtain and update patient registration (demographic and insurance) information. Obtain referrals and insurance authorizations/ precertifications prior to patient’s date of service; accurately document and assign referrals and authorizations in EPIC.

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KEY RESPONSIBILITIES
• Verifying insurance eligibility for all new and return patients, according to VMG policy and procedure.
• Use automated insurance plan eligibility databases, and/or
• Call insurance plan, or if no coverage in EPIC,
• Call patient.
• Correct all insurance coverage information as necessary.
• Perform "check-in, no visit" to pass updated coverage information to Medipac.
• If unable to contact patient or plan to verify eligibility, communicate the need for check-in staff to view the patient’s insurance card and complete the missing information, using the permanent comment field in the Patient Registration screen (F7 for additional patient information).
• Team must complete at least 100% of assigned appointments daily.
• Registering patients in the EPIC Scheduling/Registration system
• Register new patients and update return patients’ registrations at the time of appointment entry or within 48 hours of appointment time, obtaining complete and accurate demographic and insurance information, accurately completing 100% of registrations, and paying particular attention to accurate documentation of: i) Correct insurance plan code(s) ii) Correct Subscriber ID iii) Correct COB/filing order iv) Correct coverage effective/termination dates v) Correct dependent designation vi) Correct MCO/PCP authorization for services vii) Correct employer information viii) Correct guarantor demographic information ix) Correct patient demographic information x) Correct PCP identification xi) Correct referring physician identification
• Ensure that demographic and insurance information for all patients is accurate and updated according to VMG policy and procedure.
• Notify appropriate individuals of duplicate accounts, accounts containing incorrect coverage.
• Notify appropriate individuals of all transplant accounts and their claims addresses.
• Record all transactions on the daily work log, per protocol.
• Answering telephone and delivering messages.
• Communicate graciously and clearly with callers.
• Take complete messages, indicating time, date, caller, caller’s #, name of recipient, action requested by caller, initials of messenger
• Provide telephone coverage between 8 am and 5 pm.
• Clear all voice mail daily.
• In specialty practices: obtaining required authorizations for managed care patients from PCP or insurance company. In primary care practices: transmitting PCP authorizations to specialty practices.
• Expected Performance (Specialties): a) Run EPIC referral/authorization reports as needed, to ensure that patient’s visits are authorized prior their appointment date b) If insurance coverage has not been confirmed by Central Registration, contact patients whose visits/procedures have not been authorized to update their insurance information, to inform patient of patient’s liability for payment, or to defer or cancel the appointment c) Gather requisite clinical information, contact PCP or MCO, obtain referral and authorization d) Document referrals/authorizations completely in EPIC e) Assign Referrals to patient visits before their appointment date.
• Expected Performance (Primary Care): a) Assign referrals to patient visits before their appointment date, if appointment has been scheduled b) Document referrals and authorizations completely in EPIC.

TECHNICAL CAPABILITIES

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: Performs tasks that are typically routine that may impact team’s performance with occasional guidance. * Problem Solving/ Complexity of work: Utilizes some discretion and research to solve routine problems. * Breadth of Knowledge: Applies knowledge of standards, established processes and procedure that apply to your own job. * Team Interaction: Provides guidance to entry level co-workers.

Core Capabilities :

Supporting Colleagues : Develops Self and Others: Continuously improves own skills by identifying development opportunities.- Builds and Maintains Relationships: Seeks to understand colleagues’ priorities, working styles and develops relationships across areas.- Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner. Delivering Excellent Services: - Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service.- Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. - Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality: - Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards. - Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively : - Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. - Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources. - Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation : - Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action. - Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

4 years

Education:

High School Diploma or GED

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