Credentialing Coordinator II

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Oversee the comprehensive credentialing and recredentialing process for both practitioners and facilities.

• Assess provider applications and accompanying documentation to ensure they are complete and accurate.

• Execute primary source verification of licenses, certifications, education, training, board certifications, malpractice insurance, and employment history.

• Keep provider records and credentialing files in accordance with NCQA, CMS, state, and federal guidelines.

• Track processing to guarantee that applications comply with state and regulatory timelines.

• Interact with providers and practice administrators to gather missing information and address discrepancies.

• Prepare credentialing files for committee evaluation and decision-making.

• Collaborate with Provider Relations, Network Management, Compliance, and Operations teams regarding provider data and network participation.

• Assist with audits, accreditation assessments, and regulatory reporting.

• Uphold the confidentiality and security of provider data in alignment with NCQA, HIPAA, and company policies.

• Contribute to process enhancement initiatives aimed at boosting efficiency, accuracy, and the provider experience.

⛳️ Requirements

• Associate’s degree in Healthcare Administration, Business Administration, or a related field; equivalent work experience will be considered.

• Over 2 years of experience in provider credentialing, healthcare operations, provider enrollment, or a similar healthcare administrative position.

• Familiarity with credentialing standards, healthcare regulations, and accreditation criteria.

• Proficiency in provider databases, credentialing software, and Microsoft Office applications.

• Strong organizational abilities with the capacity to handle multiple priorities and deadlines.

• Exceptional verbal and written communication skills.

• Keen attention to detail and a commitment to maintaining data accuracy.

• Capability to work both independently and collaboratively within a team environment.

• Primary residence must be in 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 possess legal authorization to work in the United States at the time of application.

• Medica does not provide work visa sponsorship for this position.

🏝️ Benefits

• Competitive medical, dental, and vision benefits.

• Paid time off (PTO).

• Paid holidays.

• Paid volunteer time off.

• 401(k) contributions.

• Caregiver services.

• Additional total rewards benefits.