Payor Enrollment Manager - University of Rochester

GENERAL PURPOSE: Oversees departmental activities to ensure quality in conducting, maintaining, and communicating medical and allied health professional staff payer enrollment activities. Serves as a leading resource of the department, and collaborates with others to advance the quality of practitioners and patient safety of the facility. **JOB DUTIES AND RESPONSIBILITIES:** Delegated Credentialing/Commercial Payer Functions: 1. Supervises the payer enrollment functions related to URMFG's Delegated Credentialing and Payer Enrollment Contracts with contracted commercial payers. 2. Collaborates with the UR Contracting Department and Commercial Payers regarding new and existing contracts as they relate to the delegated credentialing functions and reviews contracts for accuracy and appropriateness. 3. Responsible for the maintenance and communication of the credentialing and payer enrollment data information provided to practitioners/providers, leaders, various department representatives as well as outside organizations such as Contracted commercial payers and health information exchange organizations. 4. Responsible for ongoing communication and collaboration with the commercial payers and URMC financial Government and Commercial Payer Enrollment Functions: 1. Supervises the payer and electronic application process for enrolling the Medical and Allied Health Professional staff with the Government Payers (Medicare & Medicaid) and with commercial payers that are not part of delegation contracts. 2. Oversee communication of the status of the applications/files or other payer enrollment/credentialing information directly to providers and various department representatives and/or outside organizations and coordinates efforts as applicable. 3. Ensures staff completion of files/applications, revalidations and the flow of information is timely and accurately 4. Ensures that files submitted securely to the respective entities upon completion and in accordance with the specific requirements. 5. Supervises the activities related to the Delegated Official with the Center for Medicare and Medicaid Services on behalf of URMFG for Provider Group and Individual Applications to participate in the government programs as required for payment of services. This includes the electronic submission of application through PECOS as well as paper applications. Regulatory and Compliance & Medical Staff Rules & Regulations, Policies and Procedures: 1. Ensures that the Medical Staff Services department is in compliance with regulatory standards including, but not limited to, The Joint Commission TJC, Center for Medicaid and Medicare Services (CMS), National Committee for Quality Assurance (NCQA), State Department of Health, Occupational Health and Safety Association (OSHA) and other regulatory agencies that govern healthcare. 2. Ensures ongoing compliance monitoring including and not limited to monitoring of license, DEA, sanctions, NPDB, complaints and adverse information regarding quality of care. 3. Ensures that provider data is securely submitted to the respective entities upon completion and in accordance with the specific requirements. 4. Collaborates with ISD Security and Privacy Officers to ensure compliance with all standards and policies. 5. Provides leadership and direction to staff pertaining to medical staff bylaw, policies and procedures. 6. Collaborates with the leadership team in the development and maintenance of credentialing policies to ensure the organization is compliant with regulatory standards and that all practices are current. 7. Provides leadership and direction to staff pertaining to medical staff bylaw, policies and procedures. Is responsible for appropriate and effective education to credentialing department staff. 8. Represents the Medical Staff Office and CVO for regulatory audit/surveys by the JC, NCQA, DOH, CMS or any other regulatory agency as needed. 9. Collaborates with various national and state leaders and associations and attends educational seminars and/or conferences to remain current with best practice, evolving standards, and technology and service options available to the industry at large. Maintain Data Systems and Statistics: 1. Develops, coordinates and monitors the quality initiative activities required by NCQA including and not limited to tracking the staff application processing accuracy and completion rates. 2. Reviews performance measures and goals with staff regularly. 3. Provides ongoing review and assessment of the departmental functions and services to identify areas in need of improvement and implement changes as needed. 4. Maintains account data to be able to provide accurate reporting on active medical and allied health professional staff profiles and information. Performance Management and Recruitment: 1. Recruits, hires, performance manages and supervises qualified staff to accomplish departmental operations and functions. 2. Responsible for thoroughly assessing performance and processes and identifying areas of opportunity for improvement of processes and utilization of resources. 3. Develops and implements tools and policies to support knowledge management, record keeping, and internal and external communication 4. Collaborates with and assists the director with the overall management and supervision of all Medical Staff Services Department staff, which includes team building and the development and implementation of retention strategies. 5. Reviews performance measures and goals with staff regularly. Develop performance improvement plans as applicable for staff not meeting goals. Additional responsibilities: 1. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise. 2. Representation of the Medical Staff Services Department for various initiatives and/or committee meeting as needed. 3. Serve as the primary back up to the MSS Department Director and other MSS Department Managers Other duties as assigned. **QUALIFICATIONS:** Bachelor's Degree required in business or healthcare related field. 5 years of experience in Medical Staff credentialing and/or payer enrollment functions required including experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing or equivalent combination of education and experience; Management experience preferred. Preferred knowledge, skills and abilities: Excellent interpersonal and communication skills with the ability to develop and maintain relationships with a variety of key stakeholders across the organization; Demonstrated success in leading through change while utilizing effective change management tools. Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS) preferred. 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: $75,300 - $113,000 Annually _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 053 URMC Medical Staff Services