Credentialing Coordinator II

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Credentialing Coordinator plays a critical role in ensuring healthcare providers meet the highest quality, compliance, and regulatory standards before joining our networks.  A Credentialing Coordinator owns the credentialing and recredentialing process from start to finish, partnering with providers, healthcare organizations, and internal teams to create a seamless onboarding experience. This role requires attention to detail, problem-solving skills, and regulatory knowledge to verify provider qualifications, ensure compliance with accreditation standards, and support the integrity of Medica's provider network.

The Credentialing Coordinator works with cross-functional partners across Provider Relations, Network Management, Compliance, and Operations while contributing to process improvements that enhance provider experience, operational efficiency, and regulatory excellence.

Key Accountabilities

• 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 in accordance with National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), state, and federal standards.
• Monitor credentialing to ensure all applications are processed within established state and regulatory timeline requirements.
• Communicate with providers and practice administrators to obtain missing information and resolve application discrepancies.
• Prepare credentialing files for committee review and credentialing decision-making.
• Partner with Provider Relations, Network Management, Compliance, and Operations teams to ensure accurate provider data and network participation.
• Support audits, accreditation reviews, and regulatory reporting activities.
• Maintain confidentiality and security of provider information in accordance with NCQA, HIPAA, and company policies.
• Assist with process improvement efforts to enhance efficiency, accuracy, and provider experience.

Required Qualifications

• 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 working 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.

Preferred Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, or related field.
• Credentialing experience within a health plan, managed care organization, or large healthcare system.
• Familiarity with NCQA, CMS, and state regulatory requirements.
• Experience with CAQH, NPPES, DEA, ABMS, NPDB, and other primary source verification websites.
• Professional credentials such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).

This position is a Remote role. To be eligible for consideration, candidates must have a primary home address located within any 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

The full salary grade for this position is $45,900 - $78,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $45,900 - $68,775. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.