Lead Revenue Cycle Advisor (PB/HB Billing & Claims preferred; EPIC exp required) - REMOTE

Vanderbilt Health; Nashville (TN); Remote; USD 90,000 - 130,000; Full time

Job summary

Vanderbilt Health in Nashville is seeking a Revenue Cycle Leader to optimize charge capture and ensure accurate reimbursement across multiple areas. You will analyze charges, resolve documentation gaps, and collaborate with clinical admins to drive improvements.

Ideal candidates have 5 years of revenue cycle experience and Epic Billing certification, with a Bachelor’s degree. This role offers growth opportunities within a large, academic health system.

Qualifications

• 5+ years of relevant work experience in revenue cycle or billing.
• Epic Professional Billing Certification in Claims or Billing.
• Bachelor's degree in a related field.

Responsibilities

• Performs analysis of charges generated from ancillary subsystems to verify the accuracy of charges and those that correlate with documented interventions.
• Identifies and resolves deficiencies in nursing/physician documentation affecting billing; supports quality audits.
• Applies reimbursement methodologies (DRGs/APCs) to secure optimal reimbursement and correct modifiers.
• Identifies appropriate charges on patient bills using medical records.
• Collaborates with clinical department admins to educate on charge capture improvement projects.
• Coordinates work and communicates charge capture and coding issues to management lines.
• Supports onboarding/training of new hires and mentors team members on new concepts and workflows.
• The responsibilities listed are a general overview and additional duties may be assigned.

Skills

Revenue Cycle

Problem Solving

Process Improvement

Education

Bachelor's

Job description

Discover Vanderbilt Health

With eight hospitals and over 180 clinics, we are the region's largest comprehensive academic health system. Vanderbilt Health has a long tradition of providing world-class care to the people of the Mid-South, living out our mission of moving medicine forward through preeminent programs in patient care, education and research. Here you'll find a spirit of collaboration and a supportive community where your expertise is valued, your knowledge expanded and your uniqueness celebrated. We are committed to fostering an environment where talented, compassionate people are united in bringing the most advanced care to our neighbors throughout the region.

Organization:

PB Billing and Claims

Job Summary:

Provides leadership in evaluating revenue cycle performance operations. Ensures appropriate reimbursement of professional and technical services for multiple areas.

KEY RESPONSIBILITIES

• Performs analysis of charges generated from ancillary subsystems to the insurance claim and/or patient statement to verify the accuracy of charges, and of charges that correlate with documented medical/nursing interventions.
• Identifies, verifies, and resolves deficiencies or discrepancies in nursing and/or physician documentation that affects billing and notifies the originator of the incorrect documentation to allow for proactive improvements related to charge capture. Assists with quality audits.
• Demonstrates and applies the various reimbursement methodologies (DRGs and APCs) to secure optimal reimbursement. Understands the relevance and impact of correct units, modifiers on reimbursement under the various methodologies.
• Identifies appropriate charges on the patient bill, utilizing documentation from the medical record.
• Collaborates with the clinical department administrators in the development and implementation of educational activities related to charge capture improvement projects.
• Coordinates work and communicates and proactively resolves critical charge capture and coding issues to multiple management lines.
• Assists with onboarding/training new hires and mentors team members on new concepts, workflow changes, processes where skills need to be enhanced (i.e. Excel functions).
• The responsibilities listed above are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES

• Revenue Cycle (Expert): Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.
• Problem Solving (Advanced): Uses critical thinking and process improvement i.e. coaches and mentors development of problem statement, describes current state, identifies root causes, creates future state, coaches and mentors development of solutions and action plans with a sustainability plan. Applies appropriate tools to address issues.
• Process Improvement (Advanced): Identifies, analyzes and improves upon existing business processes for optimization and to meet standards of quality.
• Epic Professional Billing Certified in Claims or Billing

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.

Work Experience:

Relevant Work Experience

Experience Level:

5 years

Education:

Bachelor's

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.

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.