Credentialing Specialist

Minneapolis, Minnesota
Dec 17, 2012
Jan 07, 2013
Employment Status
Full Time

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota???s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We???re an organization that???s going places. Be part of a team that cares about you, be part of UCare.

The Credentialing Specialist will assist with the coordination of the UCare provider credentialing and recredentialing process including verification of information, preparation and maintenance of credentialing files required by regulatory requirements, and the entry of information into the credentialing database and Amisys.

  • Review credentialing/recredentialing applications for required information, request missing information from providers, as necessary, conduct primary source verifications, when applicable, review data entry in credentialing database, document required information using the checklist, assure the file is in correct order and refer completed application to appropriate committee, working with Medical Directors as needed.
  • Develop and maintain good working relationships with internal and external customers acting as the initial liaison related to providers credentialing processes. 
  • Assist in the development and implementation of department policies and procedures in compliance with regulatory guidelines.
  • Attend credentialing meetings and other meeting related to the credentialing process.
  • Assist in preparation of credentialing files report, working with Medical Directors as needed, and presenting credentialing files and peer review to QIACC for approval.
  • Contact CAQ for quality of care for recredentialing files.
  • Assist in running monthly regulatory reports.

A minimum of two years relevant experience in health care related environment, preferably in a clinic business office, insurance or HMO environment. PC experience including spreadsheet, and word processing required, preferably Microsoft Access, Excel and Word.

A high school graduate or equivalent is required. Credentialing/recredentialing experience is required.   Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator Certification is strongly desired.


As an Equal Opportunity/Affirmative Action employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You???ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis???just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

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