Sr Payer Relations Coordinator - University of Rochester

Responsibilities **Job Summary** With significant latitude for independent judgment and initiative, the Senior Payer Relations Coordinator conducts specialized and complex analyses of payer issues’ impact on the University of Rochester Medical Faculty Group (URMFG) revenue cycle process. The Senior Coordinator identifies trends, investigates and makes recommendations to improve revenue. Analyzes payer policies, including interpretation of administrative and clinical edit programs. Creates communications to management, departments, and physicians. Represents URMFG with payers. Has comprehensive knowledge of payer reimbursement methodologies, rules, regulations, and contract terms. The Senior Payer Relations Coordinator is responsible for activities related to URMC’s largest payers and URMFG’s larger and/or more complex departments. Reports to the Associate Director, Payer Relations. **Key Functions and Expected Performances** With significant latitude for independent judgment and initiative: **50%** Independently researches and resolves payer issues including prior authorizations, denials management and payer policy determinations. Is integral to significant revenue recovery which contributes to enterprise financial success. Interprets reports for monitoring negotiated rate variances and recoveries. Facilitates meetings with 3 rd party payers, United Business Office (UBO), senior administrators and providers to resolve complex revenue/payer issues. Represents URMFG to external payer representatives, managers, Medical Directors and Compliance. Uses expert knowledge to influence payer outcomes beneficial to URMFG. Works in conjunction with URMC Payer Contract Managers in a team approach to payer issues. **25%** Develops, compiles, and communicates reports that monitor payer issues to internal and external stakeholders. Tracks financial recoveries to completion and conveys processes and results to peer Revenue Cycle Advisors (RCA). Provides advice to RCAs & UBO staff regarding payer reimbursement. Identifies and presents innovative improvements to increase operational efficiencies and revenue. Interprets complex financial data based on CPTs, RVUs and volume. Maintains expert knowledge of 3 rd party & government payer reimbursement, rules, regulations, coding, contract terms and conditions. Understands payer product differentiation and benefit limitations. Keeps abreast of trends related to reimbursement requirements and financial management. **15%** Provides consultation to Associate Director regarding payer/financial developments for planning, control and analytical processes. Negotiates single case agreements with non-par payers, ensuring appropriate terms/conditions. Works with Compliance Analysts, Office of Counsel, and Medical Staff Office managers regarding credentialing and payer provider file issues. Provides input in the development and implementation of systems and/or new technologies, e.g. EPIC. **10%** Mentors, trains & assists Payer Relations Coordinator staff with ad hoc projects/report design. Responsible for special projects involving reimbursement and finance. Establishes and adheres to project timelines and activity plans. Assists in developing Payer Relations policy/procedure. Other duties as may be assigned. **Background Expectations:** **Required:** 1. Bachelor’s Degree and 2-3 years’ experience with medical practice billing/coding/terminology or equivalent combination of education and/or related experience 2. Excellent organizational and problem solving skills 3. Excellent customer service & communication skills (both oral and written) 4. Ability to work in a team setting with all levels of management and staff 5. Experience with Microsoft Office products, with emphasis in Excel **Preferred:** 1. EPIC fluency and McKesson reporting knowledge 2. Demonstrated understanding of CMS RBRVS and AMA CPT 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_ **Location:** Health Sciences **Full/Part Time:** Full-Time **Opening:** Full Time 40 hours Grade 055