Administrative Specialist

Overview Vanderbilt University Medical Center (VUMC) is a leading institution in Nashville, Tennessee recognized for teaching, discovery, and patient care. The position embarks on influencing clinical outcomes through pre‑certification management. Organization Surgery PCC Admin Job Summary Performs and documents pre‑certification from insurance companies for all elective surgeries and visits, with minimal guidance. Key Responsibilities Obtains certification from insurance companies for all elective out‑patient specialty surgeries for both the surgeon and the facility. Contacts insurance review agencies to request authorization. Handles problematic certification cases with relevant internal groups. Performs investigative and follow‑up work on cases with pre‑certification issues until the issue is resolved. Documents certification process in the appropriate applications to facilitate accurate concurrent review, billing and reimbursement. Coordinates co‑pays or monies to be collected from the patient. Provides general support and isolates responsibilities as required. Performs tasks to support and obtains pre‑certifications from insurance companies. Technical Capabilities Insurance Regulatory Knowledge (Advanced) : Demonstrates knowledge of the appropriate rules and regulations for insurance policies, claims, payment and coverage. Ability to interpret and explain rules and regulations that are ambiguous or unclear. Customer Service (Intermediate) : A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs. Data Entry (Intermediate) : The ability to transcribe information from the original source into an electronic system according to written and verbal instructions efficiently and accurately. Problem Solving (Intermediate) : 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. Core Accountabilities Performs non‑routine tasks that significantly impact the team's performance with minimal guidance. Conducts research and analysis to solve some non‑routine problems. Applies broad job knowledge and has basic job skills in other areas. Provides informal guidance and support to less experienced team members. Core Capabilities Supporting Colleagues Develops Self and Others: Continuously improves own skills by identifying development opportunities. Builds and Maintains Relationships: Seeks to understand colleagues' priorities, working styles and develops relationships across area. Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner. Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service. Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensures High Quality: Performs excellent work and meets quality standards. Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond. Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Manages Resources Effectively: Demonstrates accountability, stewards organizational resources, and makes data‑driven decisions. Fosters Innovation: Generates new ideas, accepts initiatives and applies technology appropriately. Adapts to Change: Embraces changes and incorporates change instructions into own area of work. Position Qualifications Experience Level : 4 years relevant work experience. Education : High School Diploma or GED. Work Experience : Relevant Work Experience. Certifications : (not listed). Benefits The role offers a comprehensive benefits package, including health, disability, retirement and wellness offerings to support well‑being and professional growth. Equal Opportunity Statement 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. #J-18808-Ljbffr