Payer Contract and Credentialing Specialist - Full-Time 1st Shift

Nshorehc; Milwaukee (WI); On-site; USD 34,000 - 49,000; Full time

Benefits offered by this job

Up to $30/hr based on experience

Supportive Team

Growth Potential

Job summary

North Shore Health is seeking a Payer Contract and Credentialing Specialist to oversee contract matrices, credentialing, and related workflows at our Support Center. You will coordinate internal reviewers, track deadlines, and ensure timely submissions for multiple facilities and payers.

Requirements include at least 2 years in an office setting, strong Excel skills, and a Bachelor’s degree in healthcare administration or related field preferred.

Qualifications

• At least 2 years of professional work experience in an office environment.
• Proficiency in Microsoft Excel, including sorting, filtering, formulas, and reconciliation of detailed records; ability to learn payer portals and maintain organized shared documents.
• Strong written and verbal communication skills, with the ability to manage competing priorities and work independently across multiple facilities and payers.

Responsibilities

• Maintain the centralized payer contract matrix by facility, including legal entity, payer and product participation, network status, NPI, tax ID, reimbursement terms, effective dates, renewal dates, and termination or notice deadlines.
• Validate entries against executed agreements, amendments, payer confirmations, and approved facility records. Identify and resolve discrepancies with the appropriate owner.
• Maintain an organized repository of executed agreements, amendments, rate schedules, credentialing records, and related correspondence, with clear version control.
• Update contract records following approved changes and provide current participation information to Admissions, Revenue Cycle, and facility leadership.

Skills

Written and verbal communication

Ability to manage multiple facilities

Education

Bachelor’s degree in healthcare administration or related field

Tools

Microsoft Excel

Job description

#LI-AS1d

Payer Contract and Credentialing Specialist

As a North Shore Health community, our Support Center supports and strengthens our centers as trusted providers of skilled nursing and rehabilitation services. Together, we are part of the Upper Midwest's largest post-acute care network, with 64 communities across Wisconsin, united by a shared commitment to clinical excellence, compassionate care, and serving our local communities.

What We Offer You:

• Up to $30/hr based on experience
• Supportive Team
• Growth Potential
• Be part of a team committed to clinical excellence and exceptional resident-centered care.

North Shore Health is committed to advancing clinical excellence by delivering exceptional, resident-centered care across every community we serve. Guided by our core values of Trust, Engagement, Competence, Respect, and Passion, we empower our teams to provide outstanding care while continuously improving outcomes for those we serve.

What You’ll Do

Payer Contract Matrix and Document Management

• Maintain the centralized payer contract matrix by facility, including legal entity, payer and product participation, network status, NPI, tax ID, reimbursement terms, effective dates, renewal dates, and termination or notice deadlines.
• Validate entries against executed agreements, amendments, payer confirmations, and approved facility records. Identify and resolve discrepancies with the appropriate owner.
• Maintain an organized repository of executed agreements, amendments, rate schedules, credentialing records, and related correspondence, with clear version control.
• Update contract records following approved changes and provide current participation information to Admissions, Revenue Cycle, and facility leadership. Distinguish pending applications from confirmed participation and identify product-specific or facility-specific limitations.

Facility Credentialing and Recredentialing

• Maintain an annual facility credentialing review calendar and track initial enrollment, recredentialing, revalidation, and recurring document requirements according to each payer’s required schedule. Use advance reminders and internal due dates to support timely submissions.
• Collect, validate, and submit required applications and supporting documents, including licenses, insurance, ownership information, facility identifiers, and other payer-requested materials.
• Track submissions, outstanding requests, approval status, and participation effective dates. Follow up until each item is resolved, retain written payer confirmation, and promptly elevate delays or potential lapses to the designated leader.
• Coordinate payer notifications and updates for ownership, legal entity, address, license, NPI, tax ID, and other material facility changes in accordance with payer requirements and approved internal direction.

Contract Workflow Coordination

• Receive and log payer contract requests, amendments, renewals, and related correspondence. Assign or confirm the internal owner and next required action.
• Route documents to authorized financial, operational, compliance, and legal reviewers. Track questions, revisions, approvals, signatures, and deadlines.
• Follow up with internal teams and payer representatives, resolve administrative barriers, and accelerate stalled or time-sensitive items.
• Coordinate signatures through approved channels, confirm receipt of fully executed agreements, and retain final documents.
• Communicate approved participation dates, rates, authorization requirements, and billing instructions to the responsible teams. Document the source and effective date of changes, confirm receipt and completion of assigned implementation steps, and eliminate unresolved handoffs.

What You’ll Bring/Required Experience

• At least 2 years of professional work experience in an office environment.
• Proficiency in Microsoft Excel, including sorting, filtering, formulas, and reconciliation of detailed records; ability to learn payer portals and maintain organized shared documents. Strong written and verbal communication skills, with the ability to manage competing priorities and work independently across multiple facilities and payers.

Preferred Experience

• Bachelor’s degree in healthcare administration, business, or a related field preferred.
• Experience in healthcare payer contracting, facility credentialing, provider enrollment, contract administration, or revenue cycle, including hands-on responsibility for payer applications, contract records, or enrollment follow-up.
• Working knowledge of facility NPIs, tax IDs, organizational enrollment processes,
• Experience using contract management systems, payer portals, shared document repositories, or electronic signature tools.

Work Environment

• This is an on-site position based at North Shore Health’s Support Center. Work is performed in a professional office environment during established business hours. Responsibilities involve regular computer use, document review, and communication with internal teams and external partners. Consistent in-person attendance supports collaboration, timely communication, and coordination across departments.
• The employee must be able to perform the essential functions of the position, with or without reasonable accommodation.
• Candidates must be authorized to work in the United States without current or future employer sponsorship.
• Employment is contingent upon successful completion of applicable pre-employment requirements.

North Shore Health is an Equal Opportunity Employer. Employment decisions are made without regard to any characteristic protected by applicable law.