Credentialing & Patient Accounts Specialist

La Rabida Children's Hospital•Chicago, IL

11d

About The Position

A Credentialing and Patient Accounts Specialist verifies healthcare provider credentials, manages enrollment with payers, tracks license and certification expirations, and supports patient account activities to ensure compliance and smooth billing operations. The Credentialing and Patient Accounts Specialist is responsible for managing the credentialing of healthcare providers, ensuring all necessary licenses, certifications, and qualifications are valid and up to date. Additionally, this role oversees patient account processes related to provider enrollment, insurance verification, and coordination with billing teams to prevent claim delays. This position is crucial for maintaining regulatory compliance, accurate provider records, and seamless revenue cycle operations.

Requirements

Associate’s or Bachelor’s degree in Healthcare Administration, Business, or a related field preferred; comparable experience may be considered.
2-3 years in credentialing, provider enrollment, or healthcare administrative support; experience with patient accounts or billing is a plus
Proficiency with credentialing software and databases (e.g., CAQH, PECOS, NPPES, VerityStream, Cactus, IntelliSoft)
Familiarity with Microsoft Office, particularly Excel and Word
Exceptional attention to detail and accuracy
Strong organizational and time-management abilities
Effective communication skills to liaise with providers, payers, and internal Teams. Ability to manage confidential information and multi-task under pressure

Nice To Haves

CPCS (Certified Provider Credentialing Specialist) preferred
CPMSM preferred

Responsibilities

Collect, verify, and maintain provider credentials, licenses, certifications, and other required documentation
Perform primary source verification for education, medical training, licensure, DEA registrations, and malpractice coverage
Submit initial and Recredentialing applications to insurance payers including Medicare, Medicaid, and commercial plans
Monitor expiration dates for licenses, certifications, and insurance, initiating renewals as needed
Maintain organized, audit-ready credentialing files and prepare reports for committees or leadership
Communicate provider enrollment status with revenue cycle management (RCM), billing teams, and leadership to avoid claim delays
Troubleshoot enrollment rejections, data mismatches, or payer requests to ensure timely processing
Maintain accurate records of provider participation and insurance plan affiliations in credentialing databases.
Ensure all credentialing and patient account processes comply with NCQA, The Joint Commission, CMS, and state regulatory standards
Stay current with federal and state regulations related to provider credentials and insurance.
Participate in audits and provide data or documentation as required.
Develop and enhance internal credentialing and patient account processes
Coordinate between internal departments, providers, and external agencies to collect necessary information and resolve issues
Respond to inquiries from providers or payers regarding credentialing and enrollment processes.
Provide guidance or training to other staff on credentialing workflows, software use, and documentation standards.