Provider Enrollment Specialist

Job Title:
Provider Enrollment Specialist

Location:
Oak Brook, IL (Onsite/Hybrid)

Employment Type:
Full-Time, Non-Exempt

Pay
: $41,600-62,400

Position Overview

A respected healthcare organization is seeking a detail-oriented Provider Enrollment Specialist to support its credentialing operations. This role is ideal for professionals with a strong background in payer enrollment and a passion for ensuring seamless provider onboarding and compliance. The position offers the opportunity to work with a collaborative team and contribute to the success of a leading healthcare group—all while maintaining employer confidentiality.

Key Responsibilities

• Manage the complete payer enrollment lifecycle for new and existing healthcare providers, including Medicare, Medicaid, and commercial insurance plans.
• Prepare, submit, and track provider applications, contracts, and supporting documents to ensure timely enrollment and revalidation.
• Maintain and update delegated payer rosters, ensuring accuracy and compliance with regulatory timelines.
• Oversee enrollment processes for Ambulatory Surgery Centers (ASCs) and dialysis centers with all relevant payers.
• Monitor application status, proactively follow up on pending items, and resolve enrollment issues to prevent billing disruptions.
• Keep credentialing databases and systems current with provider participation and enrollment status.
• Collaborate with internal teams such as Human Resources, Revenue Cycle, and Compliance to gather and verify required information.
• Stay up to date on payer enrollment policies, guidelines, and regulatory changes.
• Serve as a liaison with insurance payers, addressing inquiries and resolving issues efficiently.
• Support audits and generate reports related to provider and facility enrollment as needed.
• Uphold strict confidentiality of provider and organizational information.

Qualifications

Minimum Requirements:

• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
• At least 2 years of direct experience in payer enrollment, with a focus on Medicare, Medicaid, and commercial payers.
• Experience with facility enrollment, including ASCs and dialysis centers, is highly preferred.
• Familiarity with delegated credentialing processes and roster submission requirements.
• Proficiency in credentialing/enrollment systems and payer portals.

Preferred Qualifications:

• Certification from a recognized credentialing organization (e.g., NAMSS CPCS or CPMSM).
• Hands-on experience with CAQH ProView, PECOS, NPPES, and payer-specific enrollment systems.
• Prior experience in nephrology, dialysis services, or multi-specialty healthcare environments.

Skills & Competencies

• Exceptional attention to detail and organizational skills.
• Ability to manage multiple projects and deadlines simultaneously.
• Strong verbal and written communication abilities.
• Independent problem-solving skills and initiative.
• High level of professionalism and discretion in handling sensitive information.

Why Consider This Role?

This is an excellent opportunity for credentialing professionals seeking to advance their careers in a reputable healthcare setting. The role offers the chance to make a meaningful impact on provider operations and patient care, all while working in a supportive and growth-oriented environment.

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our program provides employees with the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.