Credentialing Specialist

WE ARE INSIGHT:

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.

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.
• Associate’s or bachelor’s degree in healthcare administration or related field preferred.
  
  

Experience

• 1–3 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