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About the Role

The University of Rochester is seeking an individual to assist with determining coverage and access options for patients and providers, resolving reimbursement issues, and maintaining knowledge of payer systems and processes. This role is crucial in minimizing reimbursement barriers and ensuring patients can access necessary services.

Responsibilities

• Minimize reimbursement barriers for patients and providers by assisting with determining coverage and access options.
• Assist healthcare providers with questions related to payer policies, patient assistance, and reimbursement support services.
• Resolve coverage and reimbursement issues that may create barriers to patient access.
• Remain knowledgeable of private payer, Medicare, and Medicaid structure systems and reimbursement processes.
• Respond to patient, nursing, and provider account inquiries.
• Determine practitioner eligibility for enrollment.
• Complete and process paper and/or electronic applications for government and commercial payers.
• Complete applications to revalidate individual providers and University of Rochester groups with Medicare and Medicaid.
• Complete new enrollments of APPs and perform updates for commercial delegated payers.
• Ensure applications and files are securely submitted in accordance with specific requirements.
• Communicate status of files or payer enrollment/credentialing information to providers and department representatives.
• Coordinate activities related to the electronic submission of applications through the online Medicare system and paper applications.
• Analyze application and supporting documents for accuracy and completeness.
• Set up new University groups with new Tax IDs with appropriate government payers.
• Ensure files, applications, and revalidations are completed accurately and within required timeframes.
• Document and track the status of provider enrollment applications for Medicaid, Medicare, and Commercial Payers.
• Track and maintain individual provider specific information in a database for APPs for commercial delegated payers.
• Complete the Electronic Provider Assisted Claim Entry System enrollment for electronic Medicaid billing.
• Set up the Electronic Transmitter Identification Number (ETIN) for electronic Medicaid billing.
• Coordinate the transfer of data and electronic information with key leaders.
• Collaborate with providers and department representatives to obtain necessary information.
• Communicate the status of credentialing and payer enrollment files.
• Notify providers and department representatives upon approval and enrollment confirmation.
• Assist APPs with CAQH profiles.
• Collaborate with other University departments to ensure compliance with standards and policies.
• Respond to inquiries from other healthcare organizations and interface with internal and external customers on payer enrollment issues.
• Represent the department for various initiatives and committee meetings.
• Serve as primary back up to all payer enrollment staff and management.
• Serve as a Team Peer Interviewer as needed.
• Perform other duties as assigned.

Requirements

• Associate's degree and 1 year of relevant experience required.
• Equivalent combination of education and experience accepted.

Skills

• Payer enrollment
• Credentialing
• Reimbursement processes
• Medicare
• Medicaid
• Commercial payers
• Application processing
• Data tracking
• Database management
• Electronic submission systems
• CAQH profiles

Location

• Remote Work - New York, Albany, New York, United States of America, 12224

Work Type

• Full time
• Remote

Experience Level

• 1 year of relevant experience

Education Level

• Associate's degree

Salary/Compensations

• $19.04 - $26.63

About the Company

• The University of Rochester is defined by a deep commitment to Meliora - Ever Better.
• Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability.
• Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
• The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better.

Equal Opportunity

• 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 characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.