Payer Enrollment Coord IV - University of Rochester : Job Details

As a community, 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.

Job Location: 601 Elmwood Ave, Rochester, New York, United States of America, 14642

Opening: Regular

Time Type: Full time

Scheduled Weekly Hours: 40

Department: 400079 Pediatrics M&D Admin

Work Shift: UR - Day (United States of America)

Range: UR URG 107 H

Compensation Range: $23.06 - $32.29

General Purpose: Provide day-to-day information and direction to the Program Administrator, Chief Financial Officer and Clinical Administrators. Function with latitude for independent judgement and initiative in the collection of data along with, financial and reimbursement data for operational management, performance metrics, identification of revenue trends and statistical variances. Use eRecord and McKesson for analyses as well as outside resources as needed. Demonstrates ICARE* values in each of the major responsibilities.

• Manage the review, coordination, and process for third-party contract invoices and billing, ensuring timely processing and reconciliation.
• Regulate record of department contracts and initiate renewals; research fair market value reviews, collaborate with Director of Contracting, UR Legal, Division Administration and third-party companies to negotiate renewals.
• Govern mid-contract changes or updates as well as serve as support for new contract negotiations.
• Employ and utilize Tableau and EPIC for operational metrics. Advise Division Chiefs/Administrators on corrective action plans for financial operation issues.
• Implement ad-hoc data and information to providers and administrators utilizing EPIC/Tableau.
• Communicate direction and financial data to guide new program development.
• Provide payer data needed for business plans and/or budget to support the purchase of new equipment and hiring of new staff or expanding service lines.
• Partner with URMFG Payer Enrollment group and the Medical Staff Services Office to credential new providers with third party payers to ensure reimbursement for services provided. Serve as the liaison between the new provider, payer enrollment, divisional administration, EPIC system staff and Revenue Cycle Advisor to ensure timely payer enrollment.
• Process quarterly hospital revenue transfers for services funded by department but billed through hospital system.
• Point of contact for ambulance companies who transport high risk neonates to and from Golisano Children's Hospital NICU.
• Evaluate requests for payment for all ambulance transfers of newborns to and from Strong Hospital.
• Differentiate appropriate FAO to cover the costs, provide private insurance info to third party and send requests to SMH Accounts Payable for transports with Medicaid based coverage.
• Charge enter Medicaid based coverage transports into EPIC billing system.
• Lead for patients' families, social work, divisional staff, and providers in answering all billing questions, resolving disputes and obstacles to care.
• Work closely with the UBO Patient Call Center on billing related issues.
• Oversee and manage pediatric procedure room log in EPIC to ensure procedure and recovery times are appropriately documented for posting of charges.
• Control work queue during synagis season to ensure timely billing of high-priced immunization.
• Manage signatures and serve as notary for the department of pediatric providers for Medicaid Electronic Recertification forms as well as any others.
• Point of contact for several payer sites, utilized to provide sign-on for those sites for the department of pediatric staff needing access.
• Troubleshoot issues with said payer websites for access and management for multiple tax identifications.
• Collect and process correspondence sent to the billing box number.

Other duties as assigned.

• Bachelor's degree in Accounting or Business Administration, 2 years of related experience; or an equivalent combination of education and experience. Required

• Tableau
• URGEMS
• UR Financials
• COGNOS
• PEDS Personnel
• PEDS Sharepoint
• McKesson
• ePARC/EPIC
• eRecord
• Other systems access as needed

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. 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.