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

Vanderbilt Health; Tennessee; Hybrid; USD 75,000 - 95,000; Full time

Job summary

Vanderbilt Health seeks a Revenue Cycle leader to optimize the performance of billing operations across multiple service areas. You will oversee charge capture, conduct analyses of charges against medical documentation, and guide teams to secure optimal reimbursement using DRGs and APCs.

You will collaborate with clinical admins to implement educational initiatives, coordinate with managers on complex charge issues, and support onboarding of new staff while promoting process improvements across

Qualifications

• Charge capture analysis and knowledge of DRGs/APCs in reimbursement.
• Experience leading revenue cycle performance evaluations.
• Strong problem solving and coaching abilities to mentor staff.

Responsibilities

• Analyze charges from ancillary systems to validate accuracy on claims and patient statements.
• Identify and resolve documentation deficiencies affecting billing and reimbursement.
• Assist with quality audits and onboarding/new-hire training.

Skills

Revenue Cycle Expert

Problem Solving

Process Improvement

Epic Billing Certified

Education

Bachelor's

Tools

Excel

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.
• Understand 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).

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.

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 :

• - 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.
• - 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.
• - 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.
• - 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.
• - 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.

Position Qualifications:

Responsibilities: Certifications: 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.

PEOPLE ARE AT THE HEART OF ALL WE DO.

Great health care takes great people. We’re looking for like-minded individuals driven to make a difference. We invite you to explore careers at Vanderbilt Health, where we value collaboration, embrace continuous learning and foster an environment where everyone can thrive.

We’re the largest private employer in Middle Tennessee, with a growing team and an expanding footprint across towns and communities throughout the region. We employ more than 43,000 people who work in inpatient and outpatient clinical care, research and graduate medical education. Our employees also serve in critical supporting roles in administration, information technology and informatics, finance, legal and community affairs, communications and marketing, fundraising, groundskeeping and facilities, and many other departments.

Our growing academic health system has more than 2,100 licensed hospital beds at eight hospitals: Vanderbilt University HospitalMonroe Carell Jr. Children’s Hospital at Vanderbilt Vanderbilt Psychiatric Hospital Vanderbilt Stallworth Rehabilitation Hospital Vanderbilt Bedford Hospital Vanderbilt Clarksville Hospital Vanderbilt Tullahoma-Harton Hospital Vanderbilt Wilson County Hospital

Vanderbilt Health is the Mid‑South's largest provider of specialty care, with hundreds of outpatient clinic and surgical locations throughout the region, and Tennessee’s only National Cancer Institute-designated Comprehensive Cancer Center for adults and children. We are one of the nation's busiest critical care centers, home to Middle Tennessee’s only Level1 Trauma Center and Burn Center for adults and children, and Middle Tennessee’s only LevelIV Neonatal Intensive Care Unit. We are the nation’s largest transplant center, and last year we performed the most heart transplants than any center worldwide. Vanderbilt Health is an epicenter for biomedical research, winning over $1 billion in annual research awards from government, industry, foundations and donors. We are also a national leader in medical training and education, with the largest clinical training center in the Mid‑South and the only training center in Tennessee for many adult and pediatric specialties.

Three of our hospitals — Vanderbilt University Hospital, Vanderbilt Psychiatric Hospital and Vanderbilt Wilson County Hospital — have been awarded a Five‑Star Quality Rating from Medicare.

• Vanderbilt University Hospital
• Monroe Carell Jr. Children’s Hospital at Vanderbilt
• Vanderbilt Psychiatric Hospital
• Vanderbilt Stallworth Rehabilitation Hospital
• Vanderbilt Bedford Hospital
• Vanderbilt Clarksville Hospital
• Vanderbilt Tullahoma‑Harton Hospital
• Vanderbilt Wilson County Hospital

We support each other and encourage excellence among every member of our workforce. High‑achieving employees stay at Vanderbilt Health for professional growth opportunities, competitive compensation and benefits, and a sense of community and purpose. Join us in advancing health care.

Our vision: The world leader in advancing personalized health Our mission: Personalizing the patient experience through our caring spirit and distinctive capabilities