Payer Enrollment Coord IV

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 107 H

Compensation Range:

$23.06 - $32.29

Responsibilities:

Participates in the departmental activities to ensure quality in conducting, maintaining, and communicating practitioner (medical and allied health professional staff) payer enrollment activities. Serves as a resource of the department, and collaborates with others to advance the quality of practitioners and patient safety of the facility.

ESSENTIAL FUNCTIONS

Provider Application/Data Tracking and Maintenance:

• Coordinates the enrollment functions and maintains data within our software system for the purposes of delegated commercial payer enrollment.
• Analyzes the request for application and supporting documents for accurateness and completeness.
• Determines practitioner eligibility for enrollment/paneling, to include confirmation with department and/or UBO contacts.
• Coordinates the Provider Enrollment Chain & Ownership System (PECOS / Medicare Provider Database) activities related to URMFG Provider Group and Individual Applications for participation in the government program as required for payment of services.  This includes the electronic submission of applications through PECOS as well as paper applications and the surrogate requests, assignments, and approvals for providers.
• Coordinates the Provider Enrollment Chain & Ownership System (PECOS / Medicare Provider Database) activities related to the Delegated Official approval process with the Center for Medicare and Medicaid Services on behalf of URMFG.
• Reviews and tracks the status of the PECOS applications that are in process and have been approved.
• Coordinates data entry into Credentialing software system for all new practitioner enrollments and completes enrollment updates for existing practitioners for the commercial delegated payers.
• Generates and formats rosters from the credentialing software system for monthly submission to the delegated commercial payers and other internal key stakeholders.
• Coordinates additions or changes to the URMFG/hospital organizations in our software system.
• Performs ongoing maintenance and cleanup projects as needed to maintain enroll data integrity within our software system to include annual audits with department/UBO representatives.
• Works with other team leaders to ensure consistency and continuity regarding enrollment assignments.

Audits Practitioner Applications/Registrations for Completion and Accuracy:

• Audits and monitors the payer enrollment application/files processed by payer enrollment Specialist staff to ensure applications are processed in the required timeframes and meet regulatory requirements including all required primary source verifications and other documentation (as needed).
• Documents and tracks performance statistics related to accuracy as applicable and communicates to management when issues are identified.
• Collaborates with the Lead Payer Enrollment Specialist and Management to develop the methods used in auditing applications for accuracy and metrics being measured. 
• Assures the completion, quality, accuracy and security of information is in accordance with institutional guidelines. 
• Provides input and develops staff to learn and make improvements continuously. 
• Provides performance data to staff and provides tools and resources for improvement when necessary. 
• Keeps Senior Payer Enrollment Specialist and management team notified of staff progress and makes recommendations as needed for staffing and prioritization of work.
• Collaborates with the Lead Payer Enrollment Specialist and Management to develop, maintain and update the training program for new and existing staff on processing payer enrollment applications and ensures efficiency for new and existing processes. 
• Trains new and existing staff on how to process payer enrollment applications/registrations.

Liaison:

• Collaborates directly with various department/UBO representatives and commercial payer representatives to verify demographic information and research claims or payer data information issues.
• Communicates the status of applicant commercial payer enrollment to providers and various department and/or UBO representatives
• Notifies providers and various department representatives when confirmation is received from the payers that a provider has been approved and enrolled.
• Collaborates with ISD Security, Compliance and Privacy Offers to ensure compliance with all standards and policies.
• Researches Commercial and Government payer enrollment policies and requirements and implements procedures for the department as applicable.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day payer enrollment issues as they arise.
• Provides input/expertise to the payer enrollment team, management and other department representatives regarding commercial and government payer requirements and procedures.
• Problem solves, identify issues or trends and make recommendations to the management team as applicable.

Practitioner applications/registrations for payer enrollment with Commercial and Government Payers:

• Assist staff with completing paper and/or electronic individual and/or group applications for the government payers (Medicare, Medicaid, Tricare), and non-delegated commercial payers as needed. 
• Analyzes the application and supporting documents for accurateness and completeness include all required verifications and documentation as applicable.
• Sets up new URMFG groups with new Tax ID#s with the government payers as needed.
• Documents and Track the Status of Provider Enrollment Applications submitted as applicable.
• Communicates the status of the files or other payer enrollment/credentialing information directly to providers and various department representatives and/or outside organizations as applicable.
• Ensures that files are securely submitted to the respective entities upon completion and in accordance with the specific requirements

Other responsibilities:

• Assists the Department Assistant with orders for equipment and office supplies including but not limited to general supplies, capital and non-capital equipment and computers.
• Assists with issues related to equipment such as the Xerox fax machine or other office supplies/equipment.
• Represents the Medical Staff Services Department for various initiatives, projects and/or committee meeting as needed.
• Serves as the primary back up to all the payer enrollment staff and management.
• Serves as a Team Peer Interviewer as needed.

MINIMUM EDUCATION & EXPERIENCE

• Associate Degree required in business or healthcare related field or equivalent combination of education and experience. 
• 3 years of experience in Medical Staff payer enrollment and/or credentialing functions required. 

KNOWLEDGE, SKILLS AND ABILITIES

• Knowledge and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and commercial payer credentialing. 
• Experience with Microsoft Office applications required. 
• Experience with database applications preferred. 
• Excellent interpersonal and communication skills with the ability to develop and maintain relationships with a variety of key stakeholders across the organization. 

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.