Home Care Managed Care Coord

Vanderbilt University Medical Center•Nashville, TN

About The Position

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: 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.

Requirements

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.
Work Experience: Relevant Work Experience Experience Level: 5 years
Education: Bachelor's

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.