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% Provider Application/Data Tracking and Maintenance:

　　Coordinates the Provider Enrollment Chain & Ownership System (PECOS / Medicare Provider Database) activities related to URMFG Provider Group and Individual Applications for participation in the government programs as required for payment of services. This includes the electronic submission of applications through PECOS as well as paper applications and the surrogate requests, assignments, and approvals for providers.

　　Coordinates the Provider Enrollment Chain & Ownership System (PECOS / Medicare Provider Database) activities related to the Delegated Official approval process with the Center for Medicare and Medicaid Services on behalf of URMFG.

　　Reviews and tracks the status of the PECOS applications that are in process and have been approved.

　　30% Audits Practitioner Applications/Registrations for Completion and Accuracy:

　　Audits and monitors the payer enrollment application/files processed by payer enrollment Specialist staff to ensure applications are processed in the required timeframes and meet regulatory requirements including all required primary source verifications and other documentation (as needed).

　　Documents and tracks performance statistics related to accuracy as applicable and communicates to management when issues are identified.

　　Collaborates with the Lead Payer Enrollment Specialist and Management to develop the methods used in auditing applications for accuracy and metrics being measured.

　　Assures the completion, quality, accuracy and security of information is in accordance with institutional guidelines.

　　Provides input and develops staff to learn and make improvements continuously.

　　Provides performance data to staff and provides tools and resources for improvement when necessary.

　　Keeps Senior Payer Enrollment Specialist and management team notified of staff progress and makes recommendations as needed for staffing and prioritization of work.

　　Collaborates with the Lead Payer Enrollment Specialist and Management to develop, maintain and update the training program for new and existing staff on processing payer enrollment applications and ensures efficiency for new and existing processes.

　　Trains new and existing staff on how to process payer enrollment applications/registrations.

　　20% Liaison:

　　Collaborates directly with various department representatives (including billing and payer relations), and commercial and government payers to research claims issues or payer data information issues.

　　Researches Commercial and Government payer enrollment policies and requirements and implements procedures for the department as applicable.

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

　　Provides input/expertise to the payer enrollment team, management and other department representatives regarding commercial and government payer requirements and procedures.

　　Problem solves, identify issues or trends and make recommendations to the management team as applicable.

　　Notarizes applications or documents such as the Electronic Transmitter Identification Number (ETIN) for electronic Medicaid billing for individual and group enrollments as needed.

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

　　10% Practitioner applications/registrations for payer enrollment with Commercial and Government Payers:

　　Assist staff with completing paper and/or electronic individual and/or group applications for the government payers (Medicare, Medicaid, Tricare), and non-delegated commercial payers as needed.

　　Analyzes the application and supporting documents for accurateness and completeness include all required verifications and documentation as applicable.

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

　　Documents and Track the Status of Provider Enrollment Applications submitted as applicable.

　　Communicates the status of the files or other payer enrollment/credentialing information directly to providers and various department representatives and/or outside organizations as applicable.

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

　　10% Other responsibilities:

　　Assists the Department Assistant with orders for equipment and office supplies including but not limited to general supplies, capital and non-capital equipment and computers.

　　Assists with issues related to equipment such as the Xerox fax machine or other office supplies/equipment.

　　Represents the Medical Staff Services Department for various initiatives, projects and/or committee meeting 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: 3 years of experience in Medical Staff payer enrollment and/or credentialing functions required. 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: $17.64 - $24.71 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.

　　Location: Medical Faculty Group

　　Full/Part Time: Full-Time

　　Opening: Full Time 40 hours Grade 09 URMC Medical Staff Services

　　Schedule: 8 AM-4:30 PM