The successful candidate for this role will have a passion for ensuring that Vanderbilt University Medical Center's Hospitals and Providers are reimbursed according to managed care contracts and governmental policies for the medical services provided to our patients.
Other qualities for the successful candidate are polished and professional presentation skills, creative problem solving, and business process redesign with a particular interest in solutions involving automation. Experience with interpreting Managed Care Contracts fee schedules and payer policies is required.
This strategic leader will provide overall guidance for the Reimbursement Assurance team by developing goals, objectives, policies, and procedures, supervising, coordinating, and evaluating activities, participating in operating and capital expenditure budgets preparations, and performing personnel administration functions. This role is a critical element of our high-performing revenue cycle.
Oversee, monitor, and manage Reimbursement Assurance functions, including identifying and trending underpayments, communicating with payer representatives, and collaborating with our Managed Care team.
Oversee, monitor, and manage underpayment vendor activities to meet organizational Key Performance Indicators and business unit goals.
Report regularly to various leaders in the institution on the status of the team's work efforts.
Ensure strict adherence to Reimbursement Assurance internal controls, policies, and procedures
Guide efforts to streamline and automate processes to improve efficiency and accuracy in all areas of the department
Provide leadership and model behavior to promulgate the mission and the values of the institution to the department
Create an organizational culture (both within and across departments) that provides a safe, satisfying, and enriching environment for employees and provides qualified, competent staff to meet patient and departmental needs
Create an environment that encourages and supports self-development and learning for all staff through regular feedback
Goals and Objectives:
Develop departmental plans and objectives based on interpretation of institutional policy and goals.
Achieve goals and objectives by developing project plans with timelines and milestones and holding staff and peers accountable to meet agreed-upon deadlines
Analyze and evaluate ongoing department programs to identify areas where adjustments/improvements are needed
Initiate changes in or develop new policies, procedures, and methods.
Prioritize, initiate and oversee efforts to automate processes to optimize accuracy and efficiency
Participate in departmental and interdepartmental committees to address problems and facilitate information exchange about programs, questions, etc.
Identify, establish, and evaluate quality assurance standards, programs, and procedures within the department
Analyze and assess budget variances
Prepare justification or develop alternatives for cost containment/reduction
Establish and evaluate standards of performance to ensure safe, effective, and efficient operation of the department
Ensure departmental adherence to all Human Resource and VUMC policies and procedures
Participate in periodic management meetings to keep top management informed of departmental problems and concerns
Create and exceed service standards utilizing key service dimensions and knowledge of patient/customer expectations and best practices
Develop staffing plans to meet developmental objectives
Define the qualifications and performance expectations for all staff positions through the Performance Development system, including department-specific job descriptions and measurable performance standards. Ensure staff development through orientation, training programs, and work experiences
Assess staff competencies against performance expectations stated in their job descriptions (typically annually)
Supervise the team to ensure coordination and control of the work and procedures; provide advice/consultation to staff on escalated issues
Adjust work schedules or project priorities to meet emergencies or changing conditions
Qualifications - External
Bachelor's Degree (or equivalent experience) and five years' experience
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.
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