Credentialing Coordinator II
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Job Description
Credentialing Coordinator managing provider credentialing and compliance for Medica’s nonprofit health plan networks. Verifying qualifications, maintaining records, and supporting regulatory audits.
Responsibilities:
- Coordinate the end-to-end credentialing and recredentialing process for practitioners and facilities
- Review provider applications and supporting documentation for completeness and accuracy
- Conduct primary source verification of licenses, certifications, education, training, board certifications, malpractice insurance, and work history
- Maintain provider records and credentialing files according to NCQA, CMS, state, and federal standards
- Monitor processing to ensure applications meet state and regulatory timelines
- Communicate with providers and practice administrators to obtain missing information and resolve discrepancies
- Prepare credentialing files for committee review and decision-making
- Partner with Provider Relations, Network Management, Compliance, and Operations teams on provider data and network participation
- Support audits, accreditation reviews, and regulatory reporting
- Maintain confidentiality and security of provider information under NCQA, HIPAA, and company policies
- Assist with process improvement efforts to improve efficiency, accuracy, and provider experience
Requirements:
- Associate’s degree in Healthcare Administration, Business Administration, or related field; equivalent work experience may be considered
- 2+ years of experience in provider credentialing, healthcare operations, provider enrollment, or a related healthcare administrative role
- Knowledge of credentialing standards, healthcare regulations, and accreditation requirements
- Experience with provider databases, credentialing software, and Microsoft Office applications
- Strong organizational skills with the ability to manage multiple priorities and deadlines
- Excellent verbal and written communication skills
- Strong attention to detail and commitment to data accuracy
- Ability to work independently and collaboratively in a team environment
- Primary home address must be located within a state where Medica is registered as an employer: AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI
- Must be legally authorized to work in the United States at the time of application
- Medica does not offer work visa sponsorship for this role
Benefits:
- Competitive medical, dental, and vision benefits
- PTO
- Paid holidays
- Paid volunteer time off
- 401(k) contributions
- Caregiver services
- Other total rewards benefits
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