Payer Enrollment Coordinator

This is a fully remote position, open to applicants in New York.

📋 Description

• Reduces reimbursement obstacles for patients and healthcare providers by aiding in the identification of coverage and access options.

• May provide assistance to healthcare providers concerning inquiries about payer policies, patient assistance, and reimbursement support services.

• Addresses coverage and reimbursement challenges that may hinder patient access.

• Maintains a thorough understanding of the systems and reimbursement processes for private payers, Medicare, and Medicaid.

• Handles all inquiries from patients, nursing staff, and providers regarding account statuses.

• Evaluates practitioner eligibility for enrollment.

• Completes and processes all required paper and/or electronic applications for governmental payers and non-delegated commercial payers.

• Conducts applications to revalidate individual providers and University of Rochester groups with Medicare and Medicaid as mandated each cycle.

• Manages new enrollments for APPs and updates regarding changes for enrolled APPs with commercial delegated payers, such as changes in locations, tax IDs, etc.

• Ensures that applications and files are submitted securely to the relevant entities upon completion and in compliance with specific requirements.

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

• Coordinates activities related to the electronic submission of applications through the online Medicare system, in addition to paper applications.

• Reviews applications and supporting documents for accuracy and completeness, including all necessary verifications and documentation.

• Establishes new University groups with new Tax IDs with the appropriate governmental payers as required.

• Collaborates with team leaders and staff to ensure that files, applications, and revalidations are completed accurately and within the specified timeframes.

• Tracks and documents the status of provider enrollment applications for Medicaid, Medicare, and certain Commercial Payers that are not included in Delegation.

• Monitors and maintains individual provider-specific information in a database for the APPs related to commercial delegated payers for monthly submissions.

• Completes the Electronic Provider Assisted Claim Entry System enrollment for electronic Medicaid billing for new providers once they are approved by Medicaid, if applicable.

• Sets up the Electronic Transmitter Identification Number (ETIN) for electronic Medicaid billing for individual and group enrollments, if applicable.

• Facilitates the transfer of data and electronic information with key leaders, including the hospital electronic medical record team and the contracted delegated commercial payer.

• Works directly with providers and various department representatives, including billing, to gather information related to practice addresses, taxonomy codes, and to secure provider and authorized official signatures.

• Updates providers and various department representatives on the status of applicant credentialing and payer enrollment files, coordinating efforts to gather necessary information and/or documentation to meet deadlines.

• Alerts providers and various department representatives when payer approval and enrollment confirmation has been received.

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

• Collaborates with other University departments to ensure adherence to all standards and policies.

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

• Represents the department in various initiatives and/or committee meetings as required.

• Acts as the primary backup for all payer enrollment staff and management.

• Serves as a Team Peer Interviewer as needed.

• Performs other assigned duties.

⛳️ Requirements

• Associate's degree and 1 year of relevant experience are required.

• An equivalent combination of education and experience is acceptable.

🏝️ Benefits

• [Benefits details can be added here.]