Credentialing Specialist Sr

Minneapolis, Minnesota
Aug 29, 2014
Sep 22, 2014
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.

About UCare


At UCare, we deliver high-quality health coverage and services to help more than 400,000 members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.


Working at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other.


The Credentialing Specialist Senior assist with UCare provider credentialing and recredentialing process including verification of information, preparation and maintenance of credentialing files, and the entry of information into the credentialing database. In addition, responsible to ensure that applications processed within the Credentialing Department are compliant with current NCQA standards and quality errors established by the Credentialing Supervisor before being approved for “Clean File”, Credentialing Workgroup or Quality Improvement Advisory and Credentialing Counsel (QIAC) for approval. Work with the Credentialing Supervisor to maintain an evaluation system to monitor the performance and quality staff to identify areas for quality improvement.




1.      Audit applications for quality, adherence to regulatory guidelines and accuracy of information. Provide feedback to the Credentialing Supervisor on quality performance of credentialing staff.


2.      Analyze practitioner and facility credentialing applications to determine eligibility status as defined in UCare's Credentialing Plan.


3.      Assist in development and implementation of credentialing policies and procedures. 


4.      Perform primary source verification for initial and recredentialing of assigned providers utilizing NCQA Standards and other federal and state regulatory requirements.  Ensure timely verification to prevent any negative impact related to compliance or regulatory requirements. 


5.      Maintain timely communication with external providers regarding the eligibility and credentialing decisions and/or related provider issues.


6.      Serve as resource specialist for internal departments for daily issues related to provider credentialing activities.


7.      Consult with supervisor, as necessary, regarding credentialing and recredentialing applications that require additional investigation due to concerns related to professional criteria.

8.      Enter and maintain credentialing data following NCQA as well as state and federal requirements.


9.      Attend credentialing meetings and other meeting related to the credentialing process. Represent Credentialing Department at meetings, as needed.


10.   Other projects and duties as assigned.






High school diploma or equivalent required. Certified Provider Credentialing Specialist (CPCS) or Certified Medical Staff Coordinator Certification.


Required Experience


Two years relevant experience in health care related field. PC experience including spreadsheet and word processing; preferably Microsoft Access, Excel and Word.  Credentialing/re-credentialing experience required. 


Preferred Experience


Prefer experience in a clinic business office, insurance or HMO environment. Delegation of credentialing/recredentialing experience preferred. Experience working with AMISYS or similar claims application preferred. Previous supervisory or training experiences a plus.


The UCare Difference


UCare is proud to be a recognized Star Tribune Top Workplace for the 5th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards.


If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.


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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