Credentialing Specialist

At
Insight Hospital and Medical Center Chicago,we 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 Specialist. In 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.

• 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.
• 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.

• 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.

• 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.

• 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.

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…