Credentialing Specialist

CHI; Omaha (NE); Hybrid; USD 26,000 - 37,000; Full time

Job summary

CHI Health System is seeking a Credentialing Specialist to manage the end-to-end credentialing and re-credentialing for our provider network. You will ensure compliance with Joint Commission, NCQA, URAC, and CMS while maintaining accurate practitioner data.

You will handle background checks, primary source verifications, and generate reports from our credentialing database, coordinating with internal and external stakeholders to resolve discrepancies.

Qualifications

• Strong understanding of medical credentialing standards and regulatory requirements.
• Ability to perform background investigations and primary source verifications.
• Proven experience handling credentialing audits and reports.

Responsibilities

• Manage full lifecycle of practitioner files from appointment to privileging.
• Conduct background investigations and primary source verifications.
• Generate reports from the credentialing database and track eligibility.
• Serve as a key contact for stakeholders and resolve credentialing discrepancies.

Skills

Credentialing knowledge

Analytical skills

Communication skills

Education

High School Diploma or GED

Tools

Credentialing database

Job description

Job Summary And Responsibilities

As our Credentialing Specialist, you will play a pivotal role in maintaining the accuracy and integrity of our healthcare provider data. You will be responsible for coordinating the end-to-end credentialing and re-credentialing process for the CHI Health System. By ensuring strict compliance with regulatory bodies such as The Joint Commission, NCQA, URAC, and CMS, you will support our commitment to high-quality care and medical staff excellence.

As our Credentialing Specialist, you will play a pivotal role in maintaining the accuracy and integrity of our healthcare provider data. You will be responsible for coordinating the end-to-end credentialing and re-credentialing process for the CHI Health System. By ensuring strict compliance with regulatory bodies such as The Joint Commission, NCQA, URAC, and CMS, you will support our commitment to high-quality care and medical staff excellence.

Every day you will manage the full lifecycle of practitioner files, from initial appointment and clinical privileging to ongoing expirables monitoring. Your tasks will include conducting thorough background investigations, performing primary source verifications, and utilizing our credentialing database to generate reports and track eligibility. You will serve as a key point of contact for internal and external stakeholders, providing clear communication while resolving credentialing discrepancies and assisting with delegated credentialing audits.

To be successful in this role, you will bring a strong working knowledge of medical credentialing standards, hospital operations, and regulatory requirements. You must possess sharp analytical skills to interpret research findings and the ability to exercise independent judgment when handling confidential information. Proficiency in database management and report generation is essential, alongside a dedication to professionalism and the ability to effectively manage competing priorities in a fast-paced healthcare administrative environment.

Job Requirements

• High School GED General Studies, upon hire or
• High School Graduate General Studies, upon hire
• Must be located in Metro Omaha / Lincoln and surrounding area

Where You'll Work

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

Candidates needs to be located within the Metro Omaha /Lincoln and surrounding area. The position has the potential to remote after the training period.

Pay Range

$18.96 - $26.78 /hour