[Hiring] Payer Enrollment Coordinator II @University of Rochester

Role Description

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.

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.
• 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.

Qualifications

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

Requirements

• Commitment to fostering, cultivating, and preserving an inclusive and welcoming culture.
• Non-discrimination 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.