University of Rochester Payor Enrollment Specialist in Rochester, New York
Full Time 40 hours Grade 009 URMC Medical Staff Services
8 AM-4:30 PM
Under the direction of the Payer Enrollment Manager, the Payer Enrollment Specialist is responsible for the functions associated with payer enrollment of URMFG physicians and Advanced Practice Practitioners (APP) (Nurse Practitioners and Physician Assistants) with non-commercial payers (Medicare, Medicare, Tricare) and the registration of the APP providers for commercial payers on behalf of URMFG departments. This position works with URMFG billing departments with respect to proper enrollment rules and the impact on provider billing. Ensure only medical 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.
Coordinates the enrollment and registration process for new payer enrollments as well as updates for providers already enrolled with the payers. This process includes completing all paper applications for the government payers (Medicare, Medicaid, Tricare), and non-delegated commercial payers for the Advanced Practice Practitioners (APP). Maintain data on an excel spreadsheet for new enrollment and provide updates for the APPs with the commercial delegated payers.
Complete applications to revalidate all provider types and URMFG groups with Medicare and Medicaid.
Set up new groups with new Tax ID#s with the government payers.
Liaison with the billing managers and the providers to secure information related to the enrollment (practice addresses, taxonomy codes, provider and authorized official signatures). Provide the managers with application status updates. Notify department contacts 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.
Maintain current updates to the internal tracking spreadsheet on the enrollment shared drive as payer applications are mailed to the payers, track the status of the applications submitted to the payers, and the effective dates the approvals are received and the date the department contact was notified of the approval.
Assure confidentiality of documents, records and data information. Identify and report any non-compliance to manager immediately
Other duties as assigned
2 years of post-high school education in secretarial studies or the equivalent. At least 3 years of secretarial and office experience, including 1 year in a position which demonstrated the ability to work with minimum supervision and to direct an office operation. OR a combination of formal training and experience equivalent to the above.
Knowledge of payer enrollment a plus, knowledge of PC functions (Word, Excel, e-mail, Web) excellent organization and problem solving skills, proven communication skills and customer service skills, ability to work in a team setting with all levels of management and staff
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Payor Enrollment Specialist
Location: Medical Faculty Group
Job ID: 207575
Full/Part Time: Full-Time