Senior Financial Clearance Specialist (Prior Insurance Authorization exp required; V.A. exp pre[...]

Organization

VEI Oph Services 200

Job Summary

Performs and documents pre‑certification from insurance companies for all elective surgeries and visits, with minimal guidance.

Key Responsibilities

• Obtains certification from insurance companies for all elective out‑patient specialty surgeries for both the surgeon and the facility.
• Contacts insurance review agencies to request authorization.
• Handles problematic certification cases with relevant internal groups.
• Performs investigative and follow‑up work on cases with pre‑certification issues until the issue is resolved.
• Documents certification process in the appropriate applications to facilitate accurate concurrent review, billing and reimbursement.
• Coordinates co‑pays or monies to be collected from the patient.
• Supports and obtains pre‑certifications from insurance companies.

Technical Capabilities

• Insurance Regulatory Knowledge (Advanced): Demonstrates knowledge of the appropriate rules and regulations for insurance policies, claims, payment and coverage. Ability to interpret and explain rules and regulations that are ambiguous or unclear.
• Customer Service (Intermediate): A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs.
• Data Entry (Intermediate): The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately.
• Problem Solving (Intermediate): Uses critical thinking and process improvement techniques. Applies appropriate tools to address issues.

Core Accountabilities

• Performs non‑routine tasks that significantly impact team performance with minimal guidance.
• Conducts research and analysis to solve non‑routine problems.
• Provides informal guidance and support to less experienced team members.

Core Capabilities

• Supports colleagues: Develops and enhances personal skills, builds relationships across areas, communicates effectively.
• Provides excellent service: Serves others with compassion, solves complex problems, offers accurate information and support.
• Ensures high quality: Checks work quality before delivery, ensures continuous improvement, fulfills safety and regulatory requirements.
• Manages resources: Takes responsibility for activities, stewards resources, makes data‑driven decisions.
• Fosters innovation: Generates new ideas, applies technology, adapts to change.

Qualifications

• Required work experience: 4 years of relevant work experience.
• Education: High School Diploma or GED.

Benefits

This role offers the opportunity to make a meaningful impact within Vanderbilt Health, supported by a comprehensive benefits package which may include health, disability, retirement and/or wellness offerings to enhance your well‑being and professional growth.

EEO Statement

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.