Payer Enrollment & Revenue Cycle Specialist

Nephrology Associates of Northern Illinois, Ltd.; Oak Brook (IL); On-site; USD 37,000 - 39,000; Full time

Job summary

Nephrology Associates of Northern Illinois, Ltd. is seeking a Payer Enrollment Specialist with an RCM focus for our Oak Brook office.

You will manage provider and facility payer enrollment and serve as the bridge between Credentialing, Contracting, and Revenue Cycle Management to resolve denials and improve reimbursement. The ideal candidate has strong analytical skills, exceptional attention to detail, and experience with Medicare, Medicaid, and commercial payers.

Qualifications

• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
• 3-5 years provider enrollment experience.
• 2 years RCM, billing, accounts receivable, or payer denial resolution experience.
• Working knowledge of provider contracting and payer implementation processes.
• Demonstrated experience investigating and resolving credentialing, enrollment, and contracting-related claim denials.
• Strong understanding of Medicare, Medicaid, and commercial payer enrollment requirements.
• Experience working with provider enrollment systems, payer portals, and credentialing software.
• Proficiency with CAQH ProView, PECOS, NPPES, and payer-specific enrollment systems.

Responsibilities

• Serve as the subject matter expert for payer enrollment and credentialing-related claim denials.
• Review and work enrollment-related denials from Revenue Cycle teams to identify root causes and implement corrective actions.
• Partner closely with Billing, Coding, Patient Accounts, Contracting, and Revenue Cycle leadership to resolve enrollment issues impacting reimbursement.
• Coordinate timely claim corrections and resubmissions after enrollment issues have been resolved.
• Identify recurring denial trends and recommend process improvements to reduce future enrollment-related denials.
• Assist with root cause analysis for enrollment failures and develop preventive solutions.

Skills

Analytical thinking

Attention to detail

Communication skills

Organizational skills

Problem-solving

Cross-functional collaboration

Accountability

Education

Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field

Tools

CAQH ProView

PECOS

NPPES

Payer enrollment systems

Job description

Nephrology Associates of Northern Illinois, Ltd. is seeking a Payer Enrollment Specialist with an RCM focus for our Oak Brook office.

You will manage provider and facility payer enrollment and serve as the bridge between Credentialing, Contracting, and Revenue Cycle Management to resolve denials and improve reimbursement. The ideal candidate has strong analytical skills, exceptional attention to detail, and experience with Medicare, Medicaid, and commercial payers.