JOB SUMMARY: Via hospital room interview develop financial plans for patients who represent a financial risk to Vanderbilt University Hospital (uninsured and underinsured) to: minimize uncompensated care expense, maximize reimbursement and provide a customer service to the patient/guarantor; stratify time and effort by dollar, risk, and account age to maximize results; screen patients and facilitate referral to state/other funding resources. Conduct extensive proactive and aggressive follow-up on in-house and discharged accounts. Integrate efforts with the case management, social worker, and utilization management team.
Develop financial plans for un/underinsured hospitalized patients and/or facilitate funding through other programs.
Conduct interview of patients/guarantors who are physically, mentally, and financially diverse, including those who have limited English proficiency, in hospital room (including isolation rooms) gaining all required demographic and financial information.
Obtain complete credit applications from all uninsured patients, or underinsured patients per department policy.
Request and collect deposit from patient when uninsured/underinsured; establish a 3 month preliminary payment installment plan.
Educate and assist patient or guarantor with application to Medicaid or TennCare, Crime Victims Compensation, or other funding programs when criteria are met.
Identify eligibility for COBRA insurance plans and facilitate enrollment within COBRA guidelines; evaluate through credit application the patient's ability/inability to pay and recommend premium payment allocation.
Communicate discount guidelines to Amish or Mennonite community members and document discussion in computerized patient management system.
Coordinate TennCare or Medicaid applications for uninsured or underinsured patients
Thoroughly understand and apply the rules of eligibility and enrollment for TN Medicaid/TennCare, or out-of-state Medicaid programs 100% of the time.
Insure that TN Medicaid/TennCare applications are completed timely, thoroughly and accurately.
Coordinate/integrate efforts with other team members, clinicians, case managers, and social workers, where appropriate, to succeed at enrolling patients in TN Medicaid/TennCare.
Work with Department of Human Services caseworkers to insure timeliness of application dates.
Conduct extensive follow-up on pending applications, through approval or denial, to insure appropriate disposition of account; forward denied applications to outsource agency for appeal; reconcile and monitor agency progress monthly.
Prioritize time and effort by dollar, risk, and account age to maximize results
Add new accounts to worklist on day account is assigned; move to appropriate worklist at disposition of account.
Prioritize daily work by dollar, risk, and account age using worklist.
Communicate status of account to other unit members, and account reimbursement expectancy to administrative staff, per department policy.
Follow accounts proactively and aggressively 100% of the time and present status of high dollar or high risk accounts to supervisor weekly.
Contribute to unit goal of 80% successful conversion of uninsured to insured accounts.
Conduct follow-up of Medicare Secondary Payer completion for unit, as well as external units.
Reconcile and correct demographic and insurance carrier information for uninsured patients
Update demographic data with information that is accurate, including (1)Legal name vs. stat/alias name (2)Date of birth (3)Social security # (4)Billable address (5)Religious preference (6)Employer (7)Next of kin (8)Accident details
Use complex insurance plan coding system and assign corresponding plan code, using the PPO network when applicable.
Obtain necessary signatures, i.e. admission consent, advance directive, Medicare/Tricare messages, release of information, etc., from patient/guarantor for accounts assigned.
Verify insurance coverage and benefit packages
Check government program eligibility utilizing on-line mechanisms for all TennCare or uninsured patients & interpret information correctly.
Check coverage and benefit package/s utilizing on-line mechanisms for all Medicare, Blue Cross and commercially insured patients & interpret information correctly.
Use department approved insurance verification script on all insurance plans, including 3rd Party Payers, where on-line mechanisms are unavailable, & interpret information correctly.
Accurately obtain determination of coverage when pre-existing clauses, riders, or exhaust limits are present.
Accurately obtain determination if admission certification is required.
Accurately complete Medicare Secondary Payer form on-line, or hard copy when system not available, & interpret information correctly to determine primary payer.
Enter all insurance benefit information into computerized patient management system accurately.
Immediately notify Utilization Management or Patient Accounting, according to protocol, when changes to verified insurance information or insurance additions are made.
Consistently use on-line or hard copy managed care contracting mechanism for insurance contract information, insurance plan descriptions, and plan requirements.
Record process in detail and communicate identified case problems to appropriate level
Enter clear, concise, real-time documentation on account in computerized patient management system of all steps taken to increase reimbursement or to facilitate applications to financial resources, including patient/guarantor/family contact, or attempts to contact.
Enter clear, concise, real-time documentation on account in computerized patient management system of all communications with clinicians regarding patient reimbursement issues.
Immediately escalate 100% of identified case problems or high risk cases to supervisor and appropriate triad member.
Perform extensive investigative work on cases with reimbursement issues, or cases where other financial resources are being sought, until the issue is resolved.
Provide administrative support to the department
Prepare correspondence to patient/guarantor or other parties to gather information to ensure appropriate disposition of account.
Make photocopies of applications and other relevant documents and maintain according to department policy.
Attend department staff meetings on a regular basis.
Attend relevant interdepartmental in-services on a regular basis.
Vanderbilt University Medical Center is a comprehensive health care facility dedicated to patient care, research, and biomedical education. Our reputation for excellence in these areas has made us a major center for patient referrals from throughout the Mid-South. Each year, people throughout Tennessee and the Southeast choose Vanderbilt University Medical Center for their health care because of o...ur leadership in medical science and our dedication to treating patients with dignity and compassion.The mission of Vanderbilt University Medical Center is to advance health and wellness through preeminent programs in patient care, education, and research.