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University of Rochester Payer Enrollment Specialist - 216489 in Rochester, New York

Payer Enrollment Specialist

Job ID

216489

Location

Medical Faculty Group

Full/Part Time

Full-Time

Favorite Job

Regular/Temporary

Regular

Opening

Full Time 40 hours Grade 009 URMC Medical Staff Services

Schedule

8 AM-4:30 PM

Responsibilities

General Purpose:

The Payer Enrollment Specialist (PES) serves as a Medical Staff Services Professional responsible for the administrative duties required in the payer enrollment process for the initial and re-appointment applicants of the Allied Professional or Medical Staff of the University of Rochester’s Medical Faculty Group. The applicants include various types of healthcare practitioners including but not limited to physicians, dentists, physician assistants, and nurse practitioners.

Under the direction of the Payer Enrollment Manager, the PES is responsible for the functions associated with payer enrollment and/or registration of University of Rochester Medical Faculty Group (URMFG) Physicians and/or Advanced Practice Practitioners (APPs) (which includes Nurse Practitioners, Physician Assistants and other Allied Professional Staff as applicable) with non-commercial payers (Medicare, Medicare, Tricare). This position works with URMFG billing departments with respect to proper enrollment rules and the impact on provider billing. Ensure only medical and professional allied staff appointed providers are enrolled. This position maintains up-to-date and thorough knowledge of non-commercial payer enrollment obligations and NYS and Federal regulations regarding enrollment, and the commercial registration process. The PES adheres to confidentiality obligations of protecting provider information. Identifies and reports any non-compliance to manager immediately.

Responsibilities:

Coordinates the enrollment and registration process for new payer enrollments as well as updates for providers already enrolled with the payers:

  • Completes all paper applications for the government payers (Medicare, Medicaid, Tricare), and non-delegated commercial payers.

  • Coordinate and monitor the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility

  • Tracks and maintains individual provider specific information in a database for new enrollments of APPs and provides updates regarding changes for enrolled APPs for the commercial delegated payers (i.e. change in locations, tax ID’s, etc.)

  • Completes applications to revalidate individual providers as well as URMFG groups with Medicare and Medicaid.

  • Coordinate signatures from the providers, Authorized and Delegated Officials for the Medicare applications and from the University of Rochester President for Medicaid group changes

  • Sets up new URMFG groups with new Tax ID#s with the government payers as needed.

Serves as a liaison for the Medical Staff Services Department

  • 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 applicant files directly to providers and various department representatives (including billing) and coordinates efforts to obtain necessary information and/or documentation to assure deadlines are met.

  • Notifies providers and various department representatives when confirmation is received from the payers that a provider has been approved and enrolled.

  • Assist the APPs as requested with their CAQH (Committee for Affordable Quality Healthcare) profiles.

Documents and Tracks the Status of Provider Enrollment Applications:

  • Enters information onto an internal tracking spreadsheet such as:

  • Ensures only Medical and allied professional staff appointment providers are enrolled

  • Dates that payer applications are mailed to the payers

  • The status of the applications submitted to the payers

  • The effective dates the approvals are received

  • The date the department contact was notified of the approval.

Supports the Credentialing manager and/or Director as needed with projects and training and other miscellaneous job-related duties

Qualifications:

Associates degree or equivalent combination of education and/or experience. At least three years of secretarial and/or office experience and/or at least one year experience in health care/health plan setting. Organizational skills required to handle voluminous paper flow and to prioritize tasks in order to meet cyclical deadlines. Ability to manage demanding workload; self-motivated; able to carry out responsibilities with minimum supervision. Candidate must be flexible and work well in a team environment. Ability to work in a fast paced environment and multi-task and demonstrated skills related to achievement of customer satisfaction.

Preferred Qualifications:

  • Experience with Microsoft Office applications required.Experience with database applications preferred.

  • Knowledge of Payer Enrollment Practices.Working knowledge of general office practices and software applications and database management.

How To Apply

All applicants must apply online.

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