Healthcare Credentialing & Billing Specialist

Charles Drew Health Center, Inc.; Omaha (NE); On-site; USD 45,000 - 65,000; Full time

Job summary

Charles Drew Health Center, Inc. seeks a Credentialing Coordinator to manage verification, enrollment, and re-credentialing for healthcare providers. You will ensure licenses, certifications, malpractice coverage, and CMS/Nebraska DHHS compliance across the network.

Under the Finance Director, you will partner with providers, payers, and the credentialing committee, maintaining accurate provider data in CAQH and Maximus PDMS while driving process improvements and audits.

Qualifications

• 2+ years of healthcare credentialing and billing experience.
• Familiarity with NCQA or The Joint Commission standards.
• Proficiency in Excel, Word, and PowerPoint.
• Excellent customer service and collaboration skills.
• Ability to handle sensitive information with discretion.

Responsibilities

• Handle initial credentialing, privileging, and re-credentialing packets.
• Validate education, training, work history, board certifications, and active licenses.
• Monitor upcoming license/certification expirations to prevent lapses.
• Prepare documentation files and assist with audits.
• Coordinate with providers, payers, and credentialing committee.
• Input/update provider profiles in CAQH and Maximus PDMS.
• Ensure CMS, Nebraska Medicaid, and DHHS compliance.
• Serve as primary staff liaison for credentialing providers.
• Oversee enrollment of CDHC locations to maximize revenues.
• Lead procedures to monitor credentialing/compliance processes.
• Participate in professional development and leadership of projects.
• Provide secondary billing duties: claims review and inquiries.
• Other duties as assigned.

Skills

Credentialing

Billing

Customer service

Data entry

Microsoft Excel

Communication

Problem solving

Attention to detail

Education

Associate's degree (preferred)

High School Diploma or equivalent

Tools

CAQH

Maximus PDMS

Job description

Charles Drew Health Center, Inc. seeks a Credentialing Coordinator to manage verification, enrollment, and re-credentialing for healthcare providers. You will ensure licenses, certifications, malpractice coverage, and CMS/Nebraska DHHS compliance across the network.

Under the Finance Director, you will partner with providers, payers, and the credentialing committee, maintaining accurate provider data in CAQH and Maximus PDMS while driving process improvements and audits.