Credentialing & Patient Accounts Specialist
$43,680–$60,320 year
On-siteChicago, Illinois, United States
Job Summary
Verify healthcare provider credentials, collect documentation, and perform primary source verification for licensure, DEA registrations, and malpractice coverage. Submit initial and recredentialing applications to Medicare, Medicaid, and commercial payers while monitoring expiration dates to initiate renewals. Manage provider enrollment status with revenue cycle management, troubleshoot rejections and data mismatches, and maintain accurate records in credentialing databases. Ensure all processes comply with NCQA, The Joint Commission, CMS, and state standards while participating in required audits. Coordinate with internal departments, providers, and external agencies to resolve issues and provide guidance on workflows and software use.
Required Qualifications
- Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field
- 2-3 years in credentialing, provider enrollment, or healthcare administrative support
- Experience with patient accounts or billing
- 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
Desired Qualifications
- CPCS (Certified Provider Credentialing Specialist)
- CPMSM
- Experience with patient accounts or billing is a plus
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.