Insight Health Systems
Credentialing Specialist at Insight Health Systems
Pay range: $65,000 - $75,000 per year.
Overview Insight Hospital and Medical Center Chicago, located in the Bronzeville area of Chicago, seeks an organized, detail-oriented Credentialing Specialist. The role involves completing, tracking, and maintaining all payer enrollment and credentialing activities for hospital‑employed providers and hospital services, ensuring 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.
Key Responsibilities
Perform 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 oneself professionally.
Assist other departments as necessary.
Commit 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.
Qualifications
High School Diploma or GED required.
Associate’s or bachelor’s degree in healthcare administration or related field preferred.
1–3 years of experience in provider credentialing, payer enrollment, or healthcare revenue cycle required.
Experience with hospital‑based enrollment preferred.
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.
May be expected to lift up to 25 pounds or up to 50 pounds with assistance.
Visual and auditory acuity and manual dexterity essential.
May be subjected to stressful situations.
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.
Seniority Level Entry level
Employment Type Full‑time
Job Function Health Care Provider
Locations
Oak Brook, IL – $75,000.00–$85,000.00 (1 week ago)
Chicago, IL – $84,000.00–$97,000.00 (3 weeks ago)
Northbrook, IL – $50,000.00–$58,500.00 (1 week ago)
Chicago, IL – $75,000.00 (3 months ago)
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Pay range: $65,000 - $75,000 per year.
Overview Insight Hospital and Medical Center Chicago, located in the Bronzeville area of Chicago, seeks an organized, detail-oriented Credentialing Specialist. The role involves completing, tracking, and maintaining all payer enrollment and credentialing activities for hospital‑employed providers and hospital services, ensuring 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.
Key Responsibilities
Perform 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 oneself professionally.
Assist other departments as necessary.
Commit 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.
Qualifications
High School Diploma or GED required.
Associate’s or bachelor’s degree in healthcare administration or related field preferred.
1–3 years of experience in provider credentialing, payer enrollment, or healthcare revenue cycle required.
Experience with hospital‑based enrollment preferred.
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.
May be expected to lift up to 25 pounds or up to 50 pounds with assistance.
Visual and auditory acuity and manual dexterity essential.
May be subjected to stressful situations.
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.
Seniority Level Entry level
Employment Type Full‑time
Job Function Health Care Provider
Locations
Oak Brook, IL – $75,000.00–$85,000.00 (1 week ago)
Chicago, IL – $84,000.00–$97,000.00 (3 weeks ago)
Northbrook, IL – $50,000.00–$58,500.00 (1 week ago)
Chicago, IL – $75,000.00 (3 months ago)
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