Ensuring University of Rochester innovations enrich our community, improve our society, and make the world ever better
Payer Enrollment Coordinator
Location
New York
Posted
2 days ago
Salary
$19 - $26 / hour
Seniority
Junior
Job Description
Payer Enrollment Coordinator
UR Ventures
• Minimizes reimbursement barriers for patients and providers by assisting with determining coverage and access options • 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 • 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 such as change in locations, tax IDs, etc. • 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
Job Requirements
- Associate's degree and 1 year of relevant experience required
- Equivalent combination of education and experience
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