Job Title: Credentialing Specialist
Location: Oak Brook, IL
Type: Full-Time and Permanent
Schedule: Monday-Friday 8AM-5PM
Pay Range: $62K
Benefits: For eligible employees, we offer Health, Dental, and Vision insurances, in addition to a 401(k).

Position Overview: Connect Search LLC has partnered with a healthcare organization in Oak Brook, IL to fill a Credentialing Specialist opening. This role is responsible for all aspects of payer enrollment, including managing and submitting applications to Medicare, Medicaid, and commercial insurance payers, ensuring timely and accurate enrollment and revalidation for all providers and facilities.

Responsibilities:

• Manage end-to-end payer enrollment processes for new and existing providers, including Medicare, Medicaid, and commercial payers.
• Complete and submit provider applications, contracts, and required documentation for payer enrollment and revalidation.
• Submit and maintain delegated payer rosters accurately and within required timeframes.
• Oversee and complete the enrollment of ASCs and dialysis centers with all applicable payers.
• Track application status and proactively follow up to ensure timely processing and approvals.
• Maintain up-to-date records of payer participation and enrollment status in credentialing databases and systems.
• Monitor and respond to recredentialing and revalidation requirements to avoid disruptions in provider or facility billing.
• Collaborate with internal departments such as Human Resources, Revenue Cycle, and Compliance to gather and verify required information.
• Stay informed on changes to payer enrollment policies, guidelines, and regulations.
• Serve as a liaison between healthcare organization and insurance payers, addressing enrollment issues and inquiries promptly.
• Provide audit support and generate status reports on provider and facility enrollment as needed.
• Maintain strict confidentiality of provider and organizational information.

Minimum Qualifications:

• Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or a related field.
• Minimum 2 years of direct experience in payer enrollment, with emphasis on Medicare, Medicaid, and commercial payers.
• Experience in facility enrollment, including ASCs and dialysis centers, is strongly preferred.
• Understanding of delegated credentialing processes and delegated roster submission requirements.
• Proficient in credentialing/enrollment systems and payer portals.

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