American Health Care Association (AHCA), Billing, Business Administration, Communication Skills, Content Management Systems (CMS), Corporate Planning, Data Management, Data Quality, Data Sets, Demographics, Detail Oriented, Documentation, Government, Health Information Technology, Healthcare Administration, Information Technology & Information Systems, Managed Care, Medicaid, Medicare, Microsoft Excel, Multitasking, National Committee for Quality Assurance (NCQA), Network Administration/Management, Network Integration, Network Support, Onboarding, Operational Support, Organizational Skills, Presentation/Verbal Skills, Process Improvement, Provider Credentialing, Provider Relations, Quality Assurance, Reimbursement, Reporting Skills, Spreadsheets, Support Documentation, Taxonomies, Team Lead/Manager, Team Player, Technical Support, Time Management, Writing Skills
Supporting the Network Behind Exceptional Care.
Work Style: Hybrid (Onsite training for first 2 months, then hybrid schedule)
Location: Gainesville, FL
FTE: Full-Time (1.0 FTE)
Schedule: Monday – Friday - 8:00 am to 5:00 pm
The Provider Enrollment Specialist reports directly to the Provider Network Relations & Enrollment Manager and supports UF Health’s system-wide provider network operations across commercial and government payors. This role is responsible for coordinating delegated provider roster activities, validating provider information across internal systems and payor portals, and supporting enrollment reporting and data integrity initiatives that ensure provider readiness across all UF Health markets.
The Specialist must be highly organized, detail-oriented, and comfortable working with large provider data sets in a fast-paced operational environment. Responsibilities include validating and reconciling provider demographics, NPIs, TINs, practice locations, specialties, directory records, and enrollment data across multiple systems and databases. By maintaining accurate and timely provider enrollment information, this role supports payor loading, billing readiness, provider directory accuracy, operational efficiency, and overall network integrity.
This position works collaboratively with Managed Care, Credentialing, Revenue Cycle, Medical Staff, Operations, and IT teams to support provider onboarding, enrollment maintenance, payor reporting, and operational workflow coordination across the health system.
Responsibilities:
Key Responsibilities
- Prepare, review, validate, and submit delegated provider rosters to commercial and government payors in accordance with established timelines and payor requirements.
- Validate provider information including demographics, NPIs, TINs, practice locations, specialties, taxonomy codes, and participation records within payor portals and internal systems to ensure data accuracy and completeness.
- Run, reconcile, and maintain enrollment and provider data reports from credentialing systems, enrollment databases, and operational tracking tools to identify discrepancies, missing information, or enrollment issues.
- Monitor provider enrollment pipelines and assist with tracking provider onboarding, offboarding, demographic updates, and participation status across UF Health markets.
- Escalate enrollment-related issues including delayed provider loading, incorrect directory listings, missing data, or unresolved payor discrepancies impacting operational readiness or reimbursement.
- Maintain and organize large provider data sets while performing routine quality assurance reviews and data validation activities to support network integrity.
- Support provider directory maintenance activities by validating provider listings and coordinating corrections with payors and internal stakeholders.
- Assist with provider onboarding and offboarding workflows, including roster updates, payor notifications, and enrollment maintenance activities.
- Provide reporting, documentation, and operational support for delegated credentialing oversight activities, audits, compliance reviews, and payor requests.
- Collaborate with Credentialing, Revenue Cycle, IT, Medical Staff, Operations, and Managed Care teams to support aligned provider enrollment workflows and operational coordination.
- Maintain enrollment tracking tools, operational documentation, templates, and workflow resources to support standardization and reporting consistency.
- Contribute to process improvement initiatives focused on provider data accuracy, operational efficiency, reporting optimization, and enrollment workflow enhancement.
- Support special projects and operational initiatives related to provider network operations and provider data management as assigned.
Minimum Qualifications
- Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or a related field required; equivalent work experience may be considered in lieu of education
- 1–2 years of experience in provider enrollment, credentialing, provider data management, or a related healthcare administrative role
- Experience working with large data sets, spreadsheets, provider rosters, and enrollment reporting
- Strong attention to detail with the ability to validate and reconcile provider information across multiple systems
- Proficiency with Microsoft Excel and standard reporting tools
- Strong organizational and time-management skills with the ability to manage multiple priorities and meet deadlines
- Effective written and verbal communication skills with the ability to collaborate across operational teams
Preferred Qualifications
- Experience with delegated provider rosters, provider onboarding, and enrollment maintenance workflows
- Familiarity with PECOS, NPPES, Medicaid portals, Medicare enrollment processes, and commercial payor systems
- Knowledge of provider enrollment, delegated credentialing, provider directory maintenance, and payor loading processes
- Experience validating provider demographics, NPIs, TINs, practice locations, specialties, taxonomy codes, and participation records
- Familiarity with CMS, AHCA, NCQA, and delegated credentialing requirements
- Experience working within a large multi-site health system, academic medical center, or managed care environment
- Experience with credentialing or enrollment systems such as CredentialStream, MD-Staff, or related platforms