Payer Enrollment Coordinator

Responsibilities

• Minimizes reimbursement barriers for patients and providers by assisting with determining coverage and access options available for a specific product.
• Assists healthcare providers with questions related to payer policies, patient assistance, and reimbursement support services.
• Solves 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.
• Responds 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.
• 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.
• Aids 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.
• Assists with other duties as assigned.

Requirements

• Associate's degree and 1 year of relevant experience required
• Or equivalent combination of education and experience

Qualifications

• Knowledge of private payer, Medicare, and Medicaid structure systems and reimbursement processes.
• Ability to communicate effectively with providers, department representatives, and external organizations.
• Strong organizational and attention to detail skills.
• Proficiency in Microsoft Office Suite and familiarity with electronic health records (EHR).
• Excellent problem-solving and customer service skills.