Data Management Specialist, VMG Provider Enrollment

Company Name:
Vanderbilt University
## Description
The Provider Enrollment Specialist is responsible for timely and accurately enrolling providers at Vanderbilt Medical Group and affiliated locations. Responsibilities include independently coordinate and assist in data/document collection, and activities involved in the retrieval, processing, dissemination and submission of data on providers or other payers, according to our contract/delegated agreement with payers, NCQA (National Committee for Quality Assurance), Joint Commission, CAQH (Council for Affordable Quality Healthcare), and Vanderbilt By-Laws
Key Functions and Expected Performances:
1. Independently coordinate and assist in the enrollment, re-enrollment, re-validation and submission of data/documents for providers and locations in order to submit claims for payment
Accurately collect complete data and documents in accordance with the requirements of the delegated/contracted agreements and Vanderbilt Bylaws in a timely manner, paying close attention to detail.
Attend and coordinate department meetings regarding enrollment or enrollment issues.
Assure enrollment with outside Affiliates that are contracted or have signed an Agreement by coordinating data/document collection and by compiling or requesting reports as needed.
Answer phone calls/emails/faxes from various payers and/or Vanderbilt departments.
Work weekly/daily reports or work queues within a specified timeframe
Demonstrate organizational skills and assertiveness in problem-solving with effective communication of identified issues and to support high volume of workflow
2. Manage maintenance of provider records and documents, payer applications, enrollment and follow up to payers which meet requirements of policies and other parameters
Assess and verify data by manual follow-up, as necessary, with insurance payers. Coordinate changes/corrections to provider records as requested and provide complete and accurate information for audits.
Identify and report data discrepancies to the appropriate supervisor/management
Accurately input/retrieve data in the credentialing/enrollment system (VISTAR) within required timeframe
Complete provider maintenance with the payers as needed
3. May assist co-workers with workload and communicating changes in the Provider Enrollment Department
Help with the writing of polices for new procedures
Effectively communicate and educate Vanderbilt Departments regarding changes in insurance enrollment or changes in Provider Enrollment Department
Effectively use
programs and applications to aid in enrollment, if changes occur
4. Provide customer service in a timely, courteous and professional manner to Departments, Providers and their support staff
Demonstrate strong organizational and problem-solving skills.
Meet deadlines in a high pressure environment and readily handles intense interpersonal interactions with varying types of support staff and leaders across the enterprise.
5. Follow policy and procedures of the VMG Business office as well as the Vanderbilt Credo
I make those serve my highest priority.
I respect privacy and confidentiality
I conduct myself professionally
I have a sense of ownership
I am committed to my colleagues
Preferred Education, Skills, and Experiences:
Prior Insurance experience (ex. enrolling payers, etc.)
Must be detail-oriented
Excellent customer service skills
Ability to work well under pressure and in a fast-paced office
Great attendance and punctuality
Additional Information:
This is a full-time, non-exempt position (40 hours per week).
Scheduled hours are typically between the hours of 7:00 a.m. - 5:00 p.m. Monday - Friday.
Hourly rate is dependent upon education and experience.
Background screens will be performed and education will be verified prior to employment. Please be prepared to provide required information and/or documentation.
Vanderbilt is an equal opportunity, affirmative action employer
## Basic Qualifications
This position requires a High school graduate or GED and 2 years of experience or the equivalent.
Job: Research
Primary Location: TN-Nashville-VMG Business Office - Thompson Lane
Organization: VMG Provider Enrollment 303501
Job Posting: Mar 13, 2014, 2:49:43 PM
Unposting Date: Mar 22, 2014, 11:59:00 PM
Req ID: 1402541

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