Provider Enrollment Specialist

About

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.

Mission:

To transform the lives of people living with kidney disease by providing the highest quality care Description NANI is seeking a dedicated and detail-oriented Provider Enrollment Specialist to join our Credentialing Department. This role is responsible for all aspects of payer enrollment, including managing and submitting applications to Medicare, Medicaid, and commercial insurance payers, ensuring timely and accurate enrollment and revalidation for all NANI providers and facilities. The ideal candidate will bring a strong background in payer enrollment and a thorough understanding of credentialing processes. The scope of this position includes enrollment and recredentialing/revalidation of individual clinicians, submission of delegated payer rosters, and enrollment of Ambulatory Surgery Centers (ASCs) and dialysis centers in accordance with payer and regulatory requirements. Responsibilities Manage end-to-end payer enrollment, revalidation and recredentialing for providers and facilities (Medicare, Medicaid, and commercial payers) with a focus on billing readiness and claim eligibility with strict attention to billing identifiers (NPI, TIN, taxonomy, service locations, effective dates). Serve as a primary resource for enrollment-driven claim denials. Investigate payer denials by validating enrollment status across payer portals, PECOS, CAQH, and internal systems. Collaborate closely with Revenue Cycle teams to identify root causes, correct enrollment records, and support claim submissions. Proactively flag enrollment risks that may result in future denials or delayed revenue. Prepare, submit, and reconcile delegated credentialing rosters with a focus on payer acceptance and billing activation. Monitor roster discrepancies and resolve participation issues that may impact claim processing. Stay current on payer enrollment rules, CMS regulations, and reimbursement-related policy changes that affect billing outcomes. Serve as a liaison between NANI and insurance payers, addressing enrollment issues and inquiries promptly. Provide audit support and generate status reports on provider and facility enrollment as needed. Maintain strict confidentiality of provider and organizational information. Other duties as assigned. Minimum Qualifications Associate's or bachelor's degree in healthcare administration, Business Administration, or a related field. Minimum 2-3 years of experience in provider enrollment, with demonstrated exposure to billing or RCM workflows. Experience in facility enrollment, including ASCs and dialysis centers, is strongly preferred. Strong working knowledge of Medicare, Medicaid and commercial payer enrollment required. Experience in credentialing/enrollment systems and payer portals. Proficient in credentialing/enrollment systems and payer portals. Preferred Qualifications Prior experience working closely with Revenue Cycle, Billing, or Denials Management Teams. Hands-on experience with CAQH ProView, PECOS, NPPES, and payer-specific enrollment systems. Credentialing certification (NAMSS CPCS or CPMSM) preferred but not required. Skills & Competencies Strong understanding of how enrollment accuracy impacts claims and reimbursement. Exceptional attention to detail with provider and payer data. Analytical mindset with the ability to troubleshoot enrollment-related billing issues. Ability to manage multiple enrollments and denial-resolution workflows simultaneously. Independent problem-solving skills and initiative. Clear, professional communication skills for cross-departmental collaboration. High level of discretion and professionalism with handling sensitive data.

Department:

Credentialing Reports To:

Credentialing Senior Manager Location:

Hybrid -

Oak Brook, IL Job Type:

Full-Time, Non-Exempt