Responsibilities

Position Summary:

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.

Specific Responsibilities:

30% Practitioner applications/registrations for payer enrollment with Commercial and Government Payers:

• Determines practitioner eligibility for enrolment/paneling.

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

• Analyzes the application and supporting documents for accurateness and completeness include all required verifications and documentation

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

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

• Completes new enrollments of APPs and performs updates regarding changes for enrolled APPs for the commercial delegated payers (i.e. change in locations, tax ID’s, etc.)

• Communicates the status of the files or other payer enrollment/credentialing information directly to providers and various department representatives and/or outside organizations, clients or affiliates and coordinates efforts as applicable

• Works with team leaders and staff to ensure files/applications and revalidations are completed accurately and within the required timeframes.

• Ensures that applications/files are securely submitted to the respective entities upon completion and in accordance with the specific requirements.

• Coordinates activities related to the electronic submission of applications through the online Medicare system (PECOS) as well as paper applications including the collection of signatures from the providers, Authorized and Delegated Officials for the Medicare and from The University of Rochester President for Medicaid group changes as needed.

30% Provider Data Set-Up, Tracking and Maintenance:

• 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 a database (Roster) for the APPs for the commercial delegated payers for monthly submission.

• Completes the Electronic Provider Assisted Claim Entry System (ePaces) enrollment for the electronic Medicaid billing for new providers 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 information with key leaders including the hospitals electronic medical record team and the delegated commercial payers with contracts.

30% Liaison:

• 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 (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.

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

• Collaborates with ISD Security, Compliance and Privacy Offers to ensure compliance with all standards and policies.

10% Other responsibilities include:

• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day payer enrollment issues as they arise.

• Represents the Medical Staff Services Department for various initiatives and/or committee meetings as needed.

• Serves as the primary back up to all the payer enrollment staff and management.

• Serves as a Team Peer Interviewer as needed

Requirements:

Education:

Associate Degree required in business or healthcare related field or equivalent combination of education and experience.

Experience:

Previous experience in Medical Staff credentialing and/or payer enrollment functions preferred. 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 a culture of equity, diversity, and inclusion 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 status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $18.10 - $25.35 Hourly

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.

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Location: Medical Faculty Group
Full/Part Time: Full-Time
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