Payer Enrollment Analyst

Schedule: M-F 8:00am - 4:30pm (This role is onsite) 

Main Function:

The Payer Enrollment Analyst works in conjunction with regional Providers, Medical Staff Offices, Associate Services, Legal/Regulatory Affairs, URMC MSS IT, Payer enrollment software vendor and third-party payers to ensure that all regional hospital-based providers are credentialed with all applicable payers timely and accurately. Responsibilities include: 

• Coordinates completion of initial applications for third party payer enrollment for all Southern Region billing Providers (6 hospitals/5 health systems)


• Coordinates submission of signed applications to third party payers for enrollment for all Southern Region billing Providers (6 hospitals/5 health systems)


• Completes and submits all provider changes to payers as required.


• Acts as a liaison to CBO payer enrollment, URMC MSS IT and Credential Stream to develop and establish various workflows for enrollment processing based on need.


• Completes recertification’s/revalidations for third party payers.


• Maintains CAQH files including re-attestations and uploading required data with documented permissions.


• Performs all revalidations for all providers as required by CMS and commercial payers.


• Communicate with all third-party payers to establish new practice locations including CMS.


• Timely submits required documentation to payers upon termination of provider.


• Maintains workflows to ensure enrollment completion for every payer/provider requested.


• Responsible for maintaining AHP database– ensuring all providers are correctly enrolled.


• Responsible for web-based payer website provider directories, attestations, and compliance


• Responsible for monitoring and updating all payer rosters as requested.


• Responsible for review of all current payers’ use of enrollment form versions


• Acts as liaison working with URMC MSS IT team and payer enrollment software vendor to establish accurate forms mapping.


• Responsible for reporting as requesting


• Responsible for documenting all Department processes.


• Responsible for Department training material maintenance


• Responsible for training new associates as designated preceptor


• Responsible for monitoring SharePoint related department use and troubleshooting issues.


• Responsible for the Intake and Coordination of all provider enrollment requests and tracking in Managers absence.


• Required to attend scheduled meetings with each hospital, provide status of enrollments and lead in Managers absence.

Education:      

• Associate degree and 2 years’ work-related experience in health care setting required.


• Professional billing experience preferred.

Experience:

• 2 years of previous medical billing experience preferred or related healthcare experience.


• Excellent customer relations and communications skills


• Skills in using computers including Excel, Word, Box, Teams, SharePoint, and internet use required.


• Working knowledge of third-party payers


• Excellent Attention to detail

Pay Range: $24.00 - $30.00 per hr

Starting Pay: Based on Experience

Thompson Health is an EOE encouraging individuals with disabilities and veterans to apply.