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University of Rochester Sr. Payer Relations Coordinator - 220550 in Rochester, New York

Sr. Payer Relations Coordinator Job ID 220550

Location Health Sciences Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening

Full Time 40 hours Grade 054 URMC Payer Contracting & Reimb

Schedule

8 AM-4:30 PM

Responsibilities

Position Summary:

Under general direction from the Associate Director, Payer Relations and with significant latitude for Independent judgment and Initiative, the Senior Payer Relations Coordinator conducts specialized and complex analyses of payer Issues' impact on the URMFG revenue cycle process. Analyzes payers' medical, administrative policies, including interpretation of clinical editing programs. Creates communications to management, departments, and physicians. In addition to Interpreting financial reports, the Senior Coordinator Identifies trends, Investigates and makes recommendations to Improve revenue. Has comprehensive knowledge of payer reimbursement methodologies, rules, regulations, and contract terms. The Senior Payer Relations Coordinator ls responsible for activities related to URMC's largest payers and the URMFG's larger and/or more complex departments.

Responsibilities:

Responsible for Independent research and resolution of payer issues, prior authorization and denials management, policy Impact, and revenue recovery. Interprets reports for monitoring negotiated rate variances and recoveries. Facilitates multiple/regular meetings with 3t11 party payers, United Business Office (UBO) and department staff, senior administrators and providers to resolve complex revenue/payer issues. Works in conjunction with contract managers in a team approach to payer issues.

Maintains expert knowledge of 3"d party & government payer reimbursement, rules, regulations, coding, and contract terms and conditions. Understands payer product differentiation and benefit limitations. Interprets financial data based on CPTs, RVUs and volume. Works with UBO revenue cycle advisors to develop, compile, and communicate reports for monitoring of payer Issues, and tracks financial recoveries to completion. Provides advice to UBO billing staff related to 3"' party reimbursement that Identifies/presents Innovative improvements to Increase operational efficiencies and revenue. Keeps abreast of trends as they relate to reimbursement requirements and financial management.

Provides consultation to Associate Director regarding new payer/financial developments for planning, control and analytical processes. Negotiates single case agreements with non-par payers, ensuring appropriate terms/conditions. Works with Compliance analysts as needed and Medical Staff Office managers regarding credentialing and provider file Issues.

Mentors, trains & assists Junior Payer Relations Coordinator staff with ad hoc projects/report design. Responsible for special projects involving reimbursement and finance. Establishes and adheres to project timelines and activity plans. Assists in developing Payer Relations policy/procedure. Other duties as may be assigned.

Qualifications:

  • Bachelor’s Degree or equivalent combination of education and/or experience

  • Excellent organizational and problem solving skills

  • Excellent customer service & communication skills (both oral and written)

  • Ability to work in a team setting with all levels of management and staff

  • Experience with Microsoft Office products, with emphasis in Excel

    Preferred Qualifications:

  • EPIC fluency and McKesson reporting knowledge

  • 2-3 years' experience with medical practice billing/coding & medical terminology

  • Demonstrated understanding of CMS RB RVS and AMA CPT

    How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

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