Credentialing Coordinator II

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🔥 0 minutes ago

🌵 Arizona, Florida, +15 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $45.9k - $68.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Medica

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1975

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 Description

• 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