Credentialing Specialist

Chicago, IL - USA

Monthly Salary: Not Disclosed

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

WE ARE INSIGHT:

AtInsight Hospital and Medical Center Chicagowe believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet it is our mission to deliver the most compassionate loving expert and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team please apply now!

These duties are to be performed in a highly confidential manner following the mission values and behaviors of Insight Hospital and Medical Center. Employees are further expected to provide a high quality of care service and kindness toward all patients staff physicians volunteers and guests.

General Summary:

Our hospital is seeking an organized detail-oriented Credentialing this role the Payer Enrollment Specialist is responsible for completing tracking and maintaining all payer enrollment and credentialing activities for hospital-employed providers and hospital services. This role ensures timely enrollment with commercial insurance plans government payers and managed care organizations to support accurate and timely reimbursement. The specialist serves as the primary liaison between the hospital payers and providers throughout the enrollment lifecycle. This role is essential to preserving the confidentiality and safety of our patients so you must follow all federal and state regulations as well as internal policies. Our ideal applicant has an associate degree or experience in healthcare administration and payer enrollment within Illinois Michigan and Ohio.

Job Summary:

Performs a wide range of clerical duties including typing filing record keeping and secretarial support.

Comply with all external and internal audits

Provide office coverage and support to the Administrative Staff. .

Demonstrate effective communication skills and conduct self in a professional manner.

Assist other departments as necessary.

Demonstrate a commitment to understanding and implementing hospital and departmental policies and procedures.

Payer Enrollment & Credentialing

Complete initial and re-enrollment applications for Medicare Medicaid and commercial payers for hospital providers and services.

Maintain provider information in PECOS NPPES CAQH and payer-specific portals.

Submit and track changes such as additions/deletions of providers address updates reassignment of benefits and taxonomy updates.

Monitor expiration dates for licenses certifications and other credentialing requirements.

Ensure compliance with federal state and payer-specific regulations.

Data Management & Documentation

Maintain accurate and up-to-date provider enrollment files and databases.

Track submission status effective dates approvals and denials.

Prepare routine progress reports for management and revenue cycle teams.

Audit provider records regularly to ensure data integrity.

Communication & Coordination

Act as liaison between hospital departments providers and payer representatives.

Communicate enrollment status delays and payer updates to internal stakeholders.

Collaborate with HR Medical Staff Office Billing and Compliance teams to ensure smooth onboarding and billing readiness.

Problem Resolution

Identify and resolve enrollment-related issues that may delay claims processing or reimbursement.

Research payer policies and respond to requests for additional documentation.

Assist with corrections of provider claim denials due to enrollment issues.

Physical Requirements:

May be expected to lift us to 25 pounds or up to 50 pounds with assistance. Work is of light demand; sitting or walking most of the time while on duty. Visual and auditory acuity and manual dexterity essential to performing designated duties required: optimal auditory acuity required; manual dexterity involving the handling of equipment and computers is essential to performing assigned duties. Physical conditions are clean neat and well-lit. May be subjected to stressful situations. Climate control and ambient temperature variances may be experienced associated with a normal office environment.

OSHA Exposure Classification:

Job Category III. Tasks/activities do not entail predictable or unpredictable exposure to blood or other body fluids to which universal precautions apply.

Qualifications Knowledge and Ability:

Education

High School Diploma or GED required.

Associates or bachelors degree in healthcare administration or related field preferred.

Experience

13 years of experience in provider credentialing payer enrollment or healthcare revenue cycle required.

Experience with hospital-based enrollment is preferred.

Skills & Competencies

Strong knowledge of Medicare/Medicaid enrollment processes.

Familiarity with CAQH PECOS NPPES and payer portals.

Excellent organizational and time-management skills.

Strong attention to detail and data accuracy.

Ability to manage multiple priorities in a fast-paced environment.

Effective communication and customer service skills.

Proficiency in MS Office and credentialing/enrollment software.

Working Conditions

Office Hybrid or Remote work environment available.

Requires extended periods of computer work and detailed document review.

Physical Requirements

Ability to sit for long periods.

Occasional lifting of files and office materials (up to 15 lbs).

Benefits:

Paid Sick Time - effective 90 days after employment
Paid Vacation Time - effective 90 days after employment
Health vision & dental benefits - eligible at 30 days following the 1st of the following month
Short and long-term disability and basic life insurance - after 30 days of employment

Required Experience:

WE ARE INSIGHT:AtInsight Hospital and Medical Center Chicagowe believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents to build a full-service community hospital in the Bronzevil...