Payer Enrollment Coord II

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

601 Elmwood Ave, Rochester, New York, United States of America, 14642

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

910397 URMC Medical Staff Services

Work Shift:

UR - Day (United States of America)

Range:

UR URG 104 H

Compensation Range:

$18.65 - $26.11

Responsibilities:

Minimizes reimbursement barriers for patients and providers by assisting with determining coverage and access options available for a specific product. May assist healthcare providers with questions related to payer policies, patient assistance, and reimbursement support services. Resolves coverage and reimbursement issues that may create barriers to access for patients. Remains knowledgeable of private payer, Medicare, and Medicaid structure systems and reimbursement processes. Respond to all patient, nursing, and provider account inquiries.

ESSENTIAL FUNCTIONS

• Determines practitioner eligibility for enrollment. Completes and processes all paper and/or electronic applications for the government payers and non-delegated commercial payers. Completes applications to revalidate individual providers, as well as University of Rochester groups, with Medicare and Medicaid as required each cycle. Completes new enrollments of APP’s and performs updates regarding changes for enrolled APPs for the commercial delegated payers such as change in locations, tax IDs, etc. Ensures applications and files are securely submitted to the respective entities upon completion and in accordance with the specific requirements. Communicates status of files or other payer enrollment/credentialing information directly to providers, various department representatives, and/or outside organizations, clients or affiliates. Coordinates activities related to the electronic submission of applications through the online Medicare system as well as paper applications. Analyzes application and supporting documents for accurateness and completeness, including all required verifications and documentation. Sets up new University groups with new Tax IDs with the appropriate government payers as needed. Works with team leaders and staff to ensure files and/or applications and revalidations are completed accurately and within the required timeframes.
• Documents and tracks the status of provider enrollment applications for Medicaid, Medicare, and some Commercial Payers that are not part of Delegation. Tracks and maintains individual provider specific information in database for the APPs for commercial delegated payers for monthly submission. Completes the Electronic Provider Assisted Claim Entry System enrollment for electronic Medicaid billing for new provider after they are approved by Medicaid, when applicable. Sets up the Electronic Transmitter Identification Number (ETIN) for electronic Medicaid billing for individual and group enrollments, when applicable. Coordinates the transfer of data and electronic information with key leaders, including the hospital electronic medical record team and the delegated commercial payer with contracts.
• Collaborates directly with providers and various department representatives, including billing, to obtain information related to practice addresses, taxonomy codes, and to secure provider and authorized official signatures. Communicates the status of the applicants credentialing and payer enrollment files directly to providers and various department representatives and coordinates efforts to obtain necessary information and/or documentation to ensure deadlines are met. Notifies providers and various department representatives when approval and enrollment confirmation is received from the payers. Assists APPs as requested with the CAQH (Committee for Affordable Quality Healthcare) profiles. Collaborates with other University departments to ensure compliance with all standards and policies.
• Responds to inquiries from other healthcare organizations and interfaces with internal and external customers on day-to-day payer enrollment issues as they arise. Represents the department for various initiatives and/or committee meetings as needed. Serves as the primary back up to all payer enrollment staff and management. Serves as a Team Peer Interviewer as needed.
• Other duties as assigned.

MINIMUM EDUCATION & EXPERIENCE

• Associate's degree and 1 year of relevant experience required
• Or equivalent combination of education and experience

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.