Healthcare Credentialing & Compliance Lead

Charles Drew Health Centers; Omaha (NE); On-site; USD 42,000 - 68,000; Full time

Job summary

Charles Drew Health Center in Burdette/Omaha, NE seeks a Credentialing Coordinator to manage credentialing, enrollment, and re-credentialing for healthcare providers. You will ensure licenses, certifications, and malpractice insurance are current and compliant with state and federal regulations.

The role requires collaboration with providers, payers, and the credentialing committee, plus secondary billing duties and audits support.

Qualifications

• High School Diploma or equivalent required; Associate’s degree strongly preferred.
• At least 2 years of healthcare provider credentialing and billing experience.
• Experience with NCQA or The Joint Commission accreditation standards is a plus.
• Proven customer service and collaboration skills.
• Familiarity with medical terminology and credentialing databases.

Responsibilities

• Handle initial credentialing, privileging, and re-credentialing packets for healthcare providers.
• Validate education, training, work history, board certifications, and active licenses.
• Monitor upcoming license and certification expiration dates to prevent compliance lapses.
• Prepare documentation files and assist with regulatory audits.
• Coordinate with healthcare providers, insurance payers, and credentialing committee.
• Input/update provider profiles in CAQH and Maximus PDMS.
• Ensure compliance with CMS, Nebraska Medicaid, and Nebraska DHHS requirements.
• Serve as primary staff liaison for credentialing providers.
• Oversee credentialing and enrollment for CDHC locations to maximize third-party revenues.
• Lead and maintain procedures to monitor credentialing processes and compliance.
• Engage in professional development and leadership activities.
• Perform secondary billing duties including claims review and denial resolution.

Skills

Credentialing

Billing

Customer service

Microsoft Excel

Communication

Education

Associate’s degree in Business Administration or Public Health or related field

Tools

CAQH

Maximus PDMS

Job description

Charles Drew Health Center in Burdette/Omaha, NE seeks a Credentialing Coordinator to manage credentialing, enrollment, and re-credentialing for healthcare providers. You will ensure licenses, certifications, and malpractice insurance are current and compliant with state and federal regulations.

The role requires collaboration with providers, payers, and the credentialing committee, plus secondary billing duties and audits support.