Insurance Specialist (Finance)
This position serves as the liaison for USF Health and the College of Medicine regarding all aspects of government (state and federal) provider enrollment. The role is responsible for the enrollment and re-enrollment of all USFHC providers in government programs, which significantly impacts collections for the practice plan. In-depth knowledge of federal and state regulations governing provider enrollment, as well as general knowledge of billing, coding, and reimbursement, is essential. The Insurance Enrollment Specialist acts as the liaison with governmental plans, supervisors, employees, clinical department administrators, and providers. This position requires strong organizational skills, attention to detail, problem-solving abilities, the capacity to work independently, set priorities, use sound judgment, and maintain confidentiality and discretion on sensitive issues at all times.MINIMUM:
This position requires a high school diploma or equivalent with one to three years of relevant experience. Appropriate college coursework or vocational/technical training may substitute at an equivalent rate for the required experience. Proficiency with word processing and spreadsheet or database software preferred.
PREFERRED:
Previous experience in provider enrollment, credentialing, or a similar role required.
Strong organizational and time management skills.
Excellent communication and interpersonal skills.
Attention to detail and ability to manage multiple tasks simultaneously.
Proficiency in using enrollment and credentialing software Symplr
SPECIAL SKILLS/TRAINING:
Proficiency in credentialing software: SYMPLR, PECOS, NPPES, EPIC, AHCA, FLORIDA MEDICAID WEB PORTALThe University of South Florida is a high-impact global research university dedicated to student success. Over the past 10 years, no other public university in the country has risen faster in U.S. News and World Report's national university rankings than USF. Serving more than 50,000 students on campuses in Tampa, St. Petersburg and Sarasota-Manatee, USF is designated as a Preeminent State Research University by the Florida Board of Governors, placing it in the most elite category among the state's 12 public universities. USF is a member of the American Athletic Conference.
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Working at USF
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With more than 16,000 employees at USF, the University of South Florida is one of the largest employers in the Tampa Bay region. At USF you will find opportunities to excel in a rich academic environment that fosters the development and advancement of our employees. We believe in creating a talented, engaged and driven workforce through on-going development and career opportunities. We also offer a first class benefit package that includes medical, dental and life insurance plans, retirement plan options, tuition program and generous leave programs and more.
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To learn more about working at USF please visit: Work Here. Learn Here. Grow Here .Managing the enrollment process for healthcare providers with insurance companies and government programs. Collecting, reviewing, and submitting necessary documentation for provider enrollment. Review credentialing applications and corresponding documents to determine the required type of enrollment application. Perform preliminary web and phone inquiries as needed with Florida Medicaid, AHCA Clearinghouse, NPPES, EPIC, SYMPLR, and PECOS. ? Submit Surrogacy connections to providers to work on behalf of UMSA. Determine if providers need fingerprints via the AHCA Clearinghouse for enrollment into Florida. Maintain updates in SYMPLR for AHCA, Medicare, and Medicaid end dates. Submit tickets to Epic to update provider SER record. Liaising with healthcare providers to gather necessary documentation and information for enrollment or re-enrollment processes. Send out provider billing forms to set up billing once credentialed. Maintaining accurate and up-to-date records of provider credentials.
Update spreadsheet columns with application progress, noting any delays, discrepancies, or special circumstances. Utilize Epic work queues to track pending provider status concerning billing numbers, compliance requirements, or other enrollment issues. Complete assigned provider boards in the onboarding platform Monday.com. Update provider enrollment tables in Epic upon approval from payors. Participate in monthly calls with Faculty Affairs to keep all parties apprised of provider status or issues. Scan and maintain all provider documents in their designated Box folder. Maintain up-to-date records in our Credentialing software SymplrVerifying the credentials of healthcare providers, including education, training, and licensure.
Maintain individual Outlook email inbox and share responsibilities for the joint provider enrollment email inbox. Ensure all email boxes are organized and up-to-date. Regularly check the RightFax folder for incoming faxes, distributing or responding as appropriate. Sort and file all scanned mail received, ensuring proper organization and timely action. Compile and maintain documents in providers' online box files
Collaborate with fiscal agents for Medicare and Medicaid to address notices requiring providers to comply with new enrollment requirements. This may involve initiating and managing cleanup projects to ensure compliance. Assists other staff members for resolutions with enrollment and credentialing discrepancies. Support and Assist with the eligibility appeals process and provide daily support for enrollment functions
Performs other duties as assigned.
