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Cardinal Health

Coordinator, Managed Care, Credentialing What Managed Care contributes to Cardinal Health Practice Operations Management oversees the business and administrative operations of a medical practice.

Cardinal Health

Coordinator, Managed Care, Credentialing What Managed Care contributes to Cardinal Health Practice Operations Management oversees the business and administrative operations of a medical practice.

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Managed Care Credentialing information

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How much do managed care credentialing jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for managed care credentialing in the United States is $24.36, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $27.64 per hour, depending on experience, location, and employer.

What is managed care credentialing?

Managed care credentialing is the process by which healthcare organizations, such as insurance companies or managed care organizations, verify and evaluate the qualifications of healthcare providers before allowing them to join their network. This includes checking education, licensure, experience, and professional history to ensure providers meet specific standards and regulations. Credentialing helps maintain quality of care and protects patients by ensuring only qualified professionals deliver services within the network.

What are the key skills and qualifications needed to thrive in managed care credentialing?

To excel in Managed Care Credentialing, you need a thorough understanding of healthcare regulations, credentialing standards, and provider enrollment processes, often supported by experience in healthcare administration or a related certification like CPCS. Familiarity with credentialing software, databases, and compliance tracking systems such as CAQH and NCQA standards is typically required. Attention to detail, strong organizational skills, and effective communication help ensure accuracy and timely credentialing of providers. These competencies are crucial for maintaining regulatory compliance, reducing risk, and ensuring smooth operations within healthcare organizations.

What are some common challenges faced by professionals in managed care credentialing, and how can they be addressed?

Professionals in managed care credentialing often encounter challenges such as staying current with frequently changing regulations and payer requirements, keeping up with large volumes of applications, and managing tight deadlines. Effective organization, strong attention to detail, and leveraging credentialing software can help streamline processes and reduce errors. Building strong communication with providers and payers also plays a critical role in resolving issues quickly and ensuring compliance.

What is the difference between Managed Care Credentialing vs Medical Billing Specialist?

AspectManaged Care CredentialingMedical Billing Specialist
Required CredentialsCertifications in healthcare administration, insurance, or related fields; often requires knowledge of payer policiesCertification in medical billing or coding; familiarity with billing software and coding standards
Work EnvironmentHealthcare organizations, insurance companies, or credentialing firmsMedical offices, billing companies, healthcare facilities
Employer & Industry UsageUsed by healthcare providers to establish payer relationships and ensure complianceUsed to process insurance claims and manage patient billing

Managed Care Credentialing focuses on verifying provider credentials and establishing payer relationships, while Medical Billing Specialists handle billing processes and insurance claims. Both roles are essential in healthcare administration but serve different functions within the revenue cycle.

More about Managed Care Credentialing jobs

What states have the most Managed Care Credentialing jobs?

States with the most job openings for Managed Care Credentialing jobs include:

What job categories do people searching Managed Care Credentialing jobs look for?

The top searched job categories for Managed Care Credentialing jobs are:

Managed Care Credentialing jobs near you
Infographic showing various Managed Care Credentialing job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 68% Full Time, 22% Part Time, and 8% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $50,665 per year, or $24.4 per hour.

Managed Care Credentialing Coordinator

Scottish Rite for Children

Remote

Other

This job post has expired today. Applications are no longer accepted.

Scottish Rite For Children rating

8.5

Company rating: 8.5 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

55th of 1,062 rated hospitals

Job description

Managed Care Credentialing Coordinator

Our patients are our number one priority! We're committed to giving children back their childhood!

Location: Dallas - Hospital

Schedule: Monday - Friday, regular business hours: 40-hour work week

Remote - Must live in DFW Metroplex

Job Description:

Duties/Responsibilities
  • Assist leadership in the development, planning, implementation, review and revision of managed care credentialing processes, forms, related policies and procedures with regard to credentialing to stay current with Health Plans practice as well as accrediting and regulatory agency requirements (i.e., NCQA); maintain a working knowledge of such documents and keeps the medical staff updated on all changes
  • Facilitate, coordinate, prepare, monitor, maintain and implement all of the credentialing functions for medical staff and advanced practice professionals, in a timely manner, such as: managed care credentialing applications for network participation re-credentialing with health plans, monitoring, including procurement of applications and required supporting documents
  • Ensure all expirables are reviewed, obtained, maintained and managed by tracking, documenting: licensures, certifications, specialty certification, and malpractice insurance information prior to their expiration dates and other expirables as required; notify appropriate medical and administrative leadership staff prior to expiration so that required documents can be secured and updated or required intervention or actions can be accomplished in a timely manner
  • Originate or collect, update and maintain: all required documentation and records and the managed care medical staff credentialing software databases as appropriate
  • Maintain reporting and communication with hospital leadership as to credentialing status of hospital, physician staff, and advanced practice professionals
  • Regularly monitor payer websites to ensure accuracy of Scottish Rite for Children and providers in payer online tools (i.e., provider manuals); address with payer to correct any deficiencies
  • Develop annual goals and objectives for the Managed Care Credentialing function in concert with the organization's strategic plan
  • Develop, maintain, and apply working knowledge of relevant federal and state laws and regulations and accreditation standards/agencies and other regulatory requirements (i.e., NCQA)
  • Support the General Counsel in handling of legal matters for Scottish Rite, assist with special projects and help maintain files in the Office of General Counsel
  • Provide professional support to the management staff in partnership with other support staff
  • Attend meetings and take minutes for these meetings as requested
  • Assist with miscellaneous duties and special projects as assigned
Required Skills/Abilities
  • High school diploma or equivalent required
  • Associate degree preferred
  • Minimum 2 years of Medical Staff or Managed Care Credentialing Coordinator experience; in a hospital, clinic, or health plan setting is preferred
  • Certification through the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM upon hire is preferred. Otherwise, certification must be obtained within 2 years of hire or 2 years of eligibility per NAMSS requirements, as applicable
  • Proficient in computer applications (e.g., Windows, Microsoft Office, internet browsers, medical staff/credentialing software databases, etc.)
  • Knowledge of standards in managed care credentialing practiced, health plan credentialing requirements, statistics, data collection, analysis and data presentation
  • Excellent interpersonal communication, organizational and problem-solving skills

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