Credentialing, Privileging, and Enrollment Specialist (Full-Time)

OrthoNebraska creates the inspired healthcare experience all people deserve by giving people a direct path to personalized care and life-enhancing outcomes. With a focus on safety and people, we set the bar high in providing high-quality care with an unmatched experience. Our team members are critical to our success and growth and are rewarded for their dedication and hard work. IF this sounds like the type of team and environment you want to be a part of apply today!

Position Summary: The Credentialing, Privileging, and Enrollment Specialist oversees the full credentialing and privileging process for providers including credentialing, payer enrollment, privileging, and recredentialing. This role ensures compliance with all federal, state, and accreditation requirements. This position is responsible for the accurate verification, appointment, reappointment, and continuous monitoring of provider credentials to support quality patient care and organizational compliance. The specialist collaborates closely with providers, medical staff leadership, and internal teams to maintain efficient, timely, and compliant credentialing operations.

Position details

Shift

Days

FTE / Hours

1.0 / 40

Schedule

Mon - Fri: 8am - 5pm

Position Requirements

Education: Associate's Degree or equivalent combination of education and experience required.

Licensure: N/A

Certification: Certified Provider Credentialing Specialist (CPCS) preferred.

Experience: 3-5 years of healthcare experience preferred or 5-7 years of professional or executive-level communication experience in a regulated, complex environment (e.g., healthcare, legal, financial services, or corporate leadership)

Essential Job Functions

• Coordinate and administer privileging process of all initial and reappointment applications.


• Assist with the development of privilege criteria, privilege delineations, and other documents necessary for an effective credentialing process.


• Ensure that all affiliation agreements are in place and current.


• Compile all reappointment files obtained from NCVO.


• Ensure all credentialing activities comply with relevant accrediting bodies, federal and state regulations, and organizational policies.


• Assist in the development and implementation of policies and procedures related to compliance privileging and credentialing.


• Prepare files for and participate in audits, regulatory investigations, inspections by accrediting bodies, and interactions with external agencies, providing timely and accurate responses.


• Ensure OPPE and FPPE are completed in the time frame outlined in the bylaws.


• Ensure reappointment files are complete and delivered to appropriate committees.


• Oversight of Resident Files, Medical Staff Credential Files, Medical Staff Quality Files, Clinical Research and Licenses & Certificates.


• Works closely with Medical Executive Committee leadership in the development of Medical Staff Bylaws and related hospital policies assuring continuous regulatory compliance.


• Maintains and updates the Medical Staff Roster, directory, and privilege lists on the intranet ensuring accurate and up to date information.


• Attend Medical Executive Committee Meetings monthly


• Monitor and update database with key dates


• Stay informed about changes in credentialing requirements and update processes accordingly.


• Other duties as assigned.


• Physical requirements: This position is classified as Sedentary Work in the Dictionary of Occupational Titles, requiring the exertion of up to 10 pounds of force occasionally) up to (33% of the time) and/or a negligible amount of force frequently (33%-66% of the time) to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.