Payer Enrollment Coordinator III

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):

135 Corporate Woods, Rochester, New York, United States of America, 14623

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 106 H

Compensation Range:

$21.78 - $30.53

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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 moderately complex 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. Responds to all patient, nursing, and provider account inquiries.

ESSENTIAL FUNCTIONS

• Tracks and assigns practitioner applications for processing by payer enrollment specialist staff. Audits and monitors payer enrollment application/files processed by team members to ensure appointments are accurate and processed in the required timeframes. Coordinates and monitors review and analysis of practitioner applications and accompanying documents to ensure files meet regulatory requirements. Documents and tracks performance statistics related to accuracy and communicates to management when issues are identified. Reviews statistics with management and assists to identify trends. Collaborates with management to develop methods used in auditing applications for accuracy and metrics being measured. Ensures completion, quality, accuracy, and security of information in accordance with institutional guidelines. Provides input and develops staff to learn and make improvements continuously. Provides staff with performance data and tools and resources for improvement when necessary. Notifies team members and management of progress and makes recommendations as needed for corrections and prioritization of work. Develops, maintains, and updates training program for new and existing staff on processing payer enrollment applications. Ensures efficiency for new and existing processes. Trains new and existing staff on processing payer enrollment applications and registrations.
• Collaborates directly with providers and various department representatives, including billing, to obtain information related to practice addresses, taxonomy codes, and other provider data. Assists APPs as requested with their CAQH (Committee for Affordable Quality Healthcare) profiles as needed. Collaborates with internal departments to ensure compliance with all standards and policies. Solves problems, identifies issues or trends, and makes recommendations to the management team as applicable.
• Assists staff with completing paper and/or electronic applications for the government payers and non-delegated commercial payers as needed. Coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility. Analyzes application and supporting documents for accurateness and completeness, including all required verifications and documentation. Assists team with applications to revalidate individual providers, as well as department groups with Medicare and Medicaid, as needed. Documents and tracks status of Provider Enrollment Applications submitted. Communicates status of files or other payer enrollment/credentialing information directly to providers and various department representatives and/or outside organizations as applicable. Ensures files are securely submitted to the respective entities upon completion and in accordance with the specific requirements.
• Responds to inquiries from internal and external customers regarding payer enrollment issues as they arise. Represents the department for various initiatives, projects, and/or committee meeting as needed. Serves as the primary back up to payer enrollment staff and management. Serves as a Team Peer Interviewer as needed.
• Other duties as assigned.

MINIMUM EDUCATION & EXPERIENCE

• Associate's degree and 2 years 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.