Performs extensive analysis of regulatory requirements pertaining to critical revenue cycle functions to promote compliance with federal and state regulations and organizational policies. Outlines and presents strategic requirements to senior leadership to proactively implement systematic and procedural changes to ensure compliant and efficient clinical billing activities. Assists with both internal and external audits of data as required to identify opportunities for corrective action plans related to third-party audits and appeal activities.
Acts as a regulatory resource to clarify, monitor, and research regulatory requirements, provides proactive compliance monitoring and assessments with regards to key initiatives and increasing compliance requirements for a wide array of healthcare operational and financial matters including revenue cycle processing and reporting.
Analyzes and interprets data from internal/external sources to provide information to all levels of leadership.
Consolidates and summarizes findings from data to support analytical reporting to management by
Leading/Supporting the development and compilation of audit results to outside regulators, attorneys, and other stakeholders;
Performing litigation support for the Office of Legal Affairs and Office of Compliance;
Developing processes for use in evaluation of strategic decisions associated with operations and/or patient care to promote regulatory compliance;
Monitoring the workflows/processes in key clinical areas for revenue related control risks; and
Surveillance of documented revenue cycle controls and reporting on areas of deficiencies.
Analyzes and audits regulatory controls over critical revenue cycle processes.
Compiles supporting documentation (workpapers and control questionnaires) to support and defend the medical center's position in the event of third-party audits and appeals related to disputed issues.
Translates audit results into impact analysis for presentation to unit leaders and executive steering committees.
Initiates and advises on policy drafts and revisions specific to revenue cycle processes as needed.
Interfaces and maintains appropriate service with customers including Office of Compliance, Health IT, Revenue Cycle, and other physician and hospital management teams on regulatory changes, approval requirements, and audit results.
Key Responsibilities (Cont'd.)
Monitors new regulatory and/or billing requirement changes from Medicare Administrative Carriers and CMS websites and published guidance.
Performs other special projects as assigned.
Project Management (Advanced) - Planning and organizing data for review by unit leaders and executive steering committees to promote compliant actions in regards to regulatory guidance and audits.
Regulatory Compliance (Advanced) - Demonstrates expert knowledge of federal and state regulations in a complex business environment pertaining to patient charging and billing practices, patient access services, chargemaster management, payer contracting, and claims presentation.
Regulatory Documentation (Advanced) - Writes clear, concise and comprehensive documentation, such as summarized audit findings that may include financial analysis/trending impacts and system and operational improvement action plans. Incorporates data into formal presentations to provide guidance and supporting documentation for review by Office of Compliance, Office of Legal Affairs, and Executive leadership teams.
Regulatory Strategy (Advanced) - Demonstrates ability to successfully analyze and present critical information pertaining to CMS and state regulatory requirements to proactively implement systematic and policy changes. Identifies relevant stakeholders to obtain critical information for decision making and interacts with executive leaders to formalize compliant strategies.
Healthcare Data Analysis (Advanced) - Navigates within established technology environments to locate, validate, extract and format data for analysis. Able to modify and run queries and standard reports from data tools and provide critical information to unit leaders. Strong skills in data analysis and ability to break down problems into simple components and make sound decisions. Ability to contribute innovative thinking and new ideas/solutions in a multi-disciplinary team environment.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period. Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As t...he largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.