Administrative Coordinator III Payor Contracting, Enrollment & Roster Management

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Primary Purpose

Contributes to the university's success by providing administrative support for NSU Health's payor contracting function and by managing provider and group enrollment and payor roster maintenance, so NSU Health providers are enrolled, loaded correctly, and reimbursed under the correct contracted terms across its medical, dental, pharmacy, optometry, behavioral health, and audiology service lines.

Job Category:

Non-Exempt

Essential Job Functions:

Payor Contract Administration:

• Maintains the central repository of payor contracts, amendments, fee schedules, and related correspondence; ensures executed copies are filed and version-controlled.
• Maintains the contract tracking log, including effective, renewal, and termination dates, notice periods, auto-renewal terms, timely filing limits, and rate escalators; alerts management of upcoming deadlines in advance.
• Supports management and the contracts analyst on new contracts and renegotiations by gathering utilization, reimbursement, and fee schedule data, preparing comparisons and summaries, and tracking the status of open negotiations.
• Routes contracts and amendments through University review and signature workflows (Legal, Compliance, executive approval) and tracks them to execution.
• Coordinates loading of contracted fee schedules and payor setup changes into practice management systems with Revenue Cycle; spot-checks payments against contracted rates and flags suspected underpayments to management.
• Maintains the payor contact directory (provider representatives, contracting contacts, portal access) and routes payor bulletins, policy updates, and contract notices to affected departments.

Provider & Group Enrollment:

• Prepares, submits, and tracks enrollment applications for Medicare (PECOS/CMS-855), Florida Medicaid (AHCA), Medicaid managed care plans, Medicare Advantage, commercial, and dental plans for new providers, new locations, and group changes, using credential-ready files from the Provider Credentialing coordinator.
• Ensures each provider is linked to the correct group, TIN, service location, and specialty; obtains written confirmation of participation status, effective dates, and payor-assigned provider IDs.
• Manages Medicare and Medicaid revalidation cycles and responds to payor development requests by required deadlines.
• Processes changes of information with payors, including address and location changes, TIN or ownership changes, and EFT/ERA enrollment.
• Maintains the enrollment tracker (submission date, follow-ups, approval, effective date) and communicates to Practice Operations and scheduling which payors each provider may see and from what date.

Roster Management:

• Prepares and submits monthly/quarterly provider rosters to delegated and roster-based payors in each payor's required format and by its deadline.
• Processes provider additions, changes, and terminations with all affected payors within contractual notice periods.
• Reconciles payor-returned rosters and provider directories against NSU Health records and corrects discrepancies, including provider directory accuracy obligations under the No Surprises Act.

General Administration:

• Coordinates daily with the Provider Credentialing & Payor Data Cleanup coordinator, Revenue Cycle, Practice Operations, Human Resources, and Compliance so hand-offs between credentialing, enrollment, and billing are complete and nothing is dropped between teams.
• Maintains the confidentiality of provider, payor, and patient information in accordance with HIPAA and University policy.
• Documents desk-level procedures and checklists for assigned processes and keeps them current.
• Prepares status reports, trackers, correspondence, and summaries using spreadsheet, word processing, and database software.
• Learns to operate new office technologies, payor portals, and credentialing/enrollment software as they are developed and implemented.
• Completes special projects as assigned.
• Performs other duties as assigned or required.

Job Requirements:

Required Knowledge, Skills, & Abilities:

Knowledge:

• Administration and Management - Working knowledge of business and management principles involved in strategic planning, resource allocation, budgeting, human resources modeling, leadership technique, and/or coordination of people and resources.
• Clerical - Thorough knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, designing forms, and other office procedures and terminology.
• Customer and Personal Service - Thorough knowledge of principles and processes for providing customer and personal services. This includes needs assessment, meeting quality standards for services, and evaluation of user satisfaction.
• English Language - Thorough knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
• Computers and Electronics - General knowledge of computer hardware and software, including applications, programming, and/or systems configuration.
• Advanced knowledge of MS Office Suite (Outlook, Word, Excel, PowerPoint), including Excel for tracking, reconciliation, and roster files.
• Payor Enrollment - Working knowledge of provider and group enrollment processes, including PECOS/CMS-855, Florida Medicaid (AHCA) enrollment, CAQH, NPPES, revalidation, and EFT/ERA enrollment.
• Managed Care Contracting - General knowledge of payor contract terms, including fee schedules, reimbursement methodologies, timely filing, notice and termination provisions, and amendments.
• Health Insurance and Revenue Cycle - General knowledge of commercial, Medicare, Medicaid/managed care, and dental plans, and of how enrollment and roster errors cause claim denials.
• Practice Management Systems - Familiarity with practice management/billing systems (NextGen, Axium, or similar), payor web portals (e.g., Availity), and HIPAA requirements.

Skills:

• Service Orientation - Proficient skills in actively looking for ways to help people.
• Judgment and Decision Making - Proficient skills in considering the relative costs and benefits of potential actions to choose the appropriate one.
• Time Management - Proficient skills in managing one's own time and the time of others.
• Social Perceptiveness - Proficient skills in being aware of others' reactions and understanding why they react as they do.
• Writing - Proficient skills in communicating effectively in writing as appropriate for the needs of the audience.
• Speaking - Proficient skills in talking to others to convey information effectively.
• Active Listening - Proficient skills in giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Reading Comprehension - Proficient understanding of written sentences and paragraphs in work-related documents.
• Attention to Detail and Follow-Through - Proficient skills in managing a high volume of applications, deadlines, and payor follow-ups accurately and to completion.

Abilities:

• Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
• Selective Attention - The ability to concentrate on a task over a period of time without being distracted.
• Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense.
• Near Vision - Must be able to see details at close range (within a few feet of the observer).

Physical Requirements:

• Speech Recognition - Must be able to identify and understand the speech of another person.
• Speech Clarity - Must be able to speak clearly so others can understand you.
• Near Vision - Must be able to see details at close range (within a few feet of the observer).
• Travel - May be required to travel between NSU Health clinic locations.
• May be required to work nights or weekends.
• May be exposed to short, intermittent, and/or prolonged periods of sitting and/or standing in performance of job duties.
• May be