Credentialing, Manager

Nephrology Associates of Northern Illinois, Ltd.; Oak Brook (IL); Hybrid; USD 100,000 - 115,000; Full time

Job summary

Nephrology Associates of Northern Illinois, Ltd. seeks an experienced Credentialing Manager to lead credentialing operations, payer enrollment, and related processes in a hybrid Oak Brook, IL setting.

The role requires meticulous oversight of revalidations and contract management, ensuring provider data integrity. The ideal candidate brings 5–7+ years in credentialing, familiarity with PHOs, and strong leadership to drive efficiencies and reduce denials.

Qualifications

• 5–7+ years of experience in medical credentialing and payer enrollment.
• Experience with Medicare/Medicaid enrollment and revalidations.
• Background working with RH/PHOs or PHOs preferred.

Responsibilities

• Direct and manage credentialing, recredentialing, and payer enrollment for providers and facilities.
• Maintain calendar and tracking for credentialing timelines and deadlines.
• Lead payer roster submissions and ensure data accuracy to reduce denials.
• Oversee payer contract enrollment from application to approval and communicate with payer representatives.
• Administer EFT/ERA enrollment across payers.

Skills

Credentialing

Payer enrollment

PHO collaboration

Leadership

Education

Bachelor’s in healthcare administration/Business

Tools

CAQH

PECOS

Payer portals

Cloud-based tools

Job description

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Credentialing, Manager

Full Time Corporate Corporate, Oak Brook, IL, US

2 days ago Requisition ID: 1186

Salary Range: $100,000.00 To $115,000.00 Annually

Credentialing, Manager

Why NANI?

NANI is the nation’s largest Nephrology practice. We have provided excellence in specialty kidney care for over 50 years. NANI’s nephrology practices are primarily operated in northern Illinois and throughout northern and central Indiana, with additional locations in New Jersey. NANI’s scope of care and services includes difficult-to-control hypertension, kidney disease, kidney injury, kidney transplant, and related services, as well as groundbreaking and lifesaving clinical research and consulting services.

Join Our Team!

Job Title: Credentialing, Manager

Location: In-office (open to Hybrid work schedule)

Department: Revenue Cycle / Credentialing

Reports To: Director of Revenue Cycle

FLSA Status: Exempt

Position Summary:

We are seeking an experienced and detail-oriented Senior Manager of Credentialing to lead and oversee all credentialing operations, including payer enrollment, Medicare/Medicaid revalidations, payer roster submissions, contract management, EFT/ERA setup, and portal administration. This role is instrumental in maintaining provider compliance and payer alignment across a complex, multi-entity environment.

The ideal candidate brings deep expertise in credentialing and payer engagement, strong technological acumen, and hands‑on experience in revenue cycle management. Prior experience working with Physician-Hospital Organizations (PHOs) is highly desirable.

Key Responsibilities:

• Direct and manage all aspects of provider and facility credentialing, recredentialing, and payer enrollment—including Medicare and Medicaid revalidations—ensuring timely and accurate submissions.
• Maintain a robust calendar and tracking system to manage credentialing timelines, expirations, and compliance deadlines.
• Lead the timely submission of payer rosters, ensuring alignment with current provider data and reducing claim denials.
• Oversee payer contract enrollment processes from initial application through approval, including effective communication and follow-up with payer representatives.
• Administer and optimize EFT/ERA enrollment with all commercial and governmental payers.
• Manage access and usage of payer and credentialing portals, ensuring data accuracy and appropriate user access across teams.
• Serve as a liaison with Physician-Hospital Organizations (PHOs) and partner entities for credentialing alignment, shared rosters, and contract consistency.
• Champion the use of technology to organize, store, and monitor credentialing data, leveraging tools such as credentialing databases, cloud platforms, and dashboard reporting systems.
• Collaborate with internal teams including Revenue Cycle, Compliance, Legal, and Operations to ensure provider data integrity and readiness.
• Provide regular reporting and status updates to leadership on credentialing metrics, compliance risks, and opportunities for process improvement.
• Recruit, develop, and supervise a credentialing team focused on efficiency, accuracy, and service excellence.

Qualifications:

• Bachelor’s degree in healthcare administration, Business, or related field (Master’s preferred).
• 5–7+ years of experience in medical credentialing, including payer enrollment, revalidations, EFT/ERA setup, and roster management.
• Hands‑on experience with Medicare and Medicaid enrollment and revalidation processes.
• Proven background working in or closely with Revenue Cycle Management teams.
• Experience working within or alongside Physician‑Hospital Organizations (PHOs).
• Strong proficiency with credentialing software (e.g., CAQH, PECOS), payer portals, and cloud‑based organizational tools.
• Detail‑oriented, deadline‑driven, and adept at managing large datasets with accuracy.
• Excellent communication and leadership skills; able to interact professionally with providers, payers, and executive teams.

Preferred Skills:

• Multi‑state credentialing and high‑volume provider group experience.
• Familiarity with value‑based care models and PHO collaborative frameworks.
• Project management or process improvement experience.