Credentialing Coordinator
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Job Description
Credentialing Coordinator managing provider credentialing, renewals, and payer enrollment for Pediatric Home Service’s pediatric home healthcare operations. Supporting compliance across Minnesota, Kansas, and multiple healthcare locations.
Responsibilities:
- Coordinate provider credentialing and recredentialing processes in accordance with regulatory requirements and organizational standards
- Collect, review, and verify provider documentation, including licenses, certifications, education, work history, malpractice insurance, and references
- Track license, certification, and credential expiration dates and help ensure timely renewals
- Complete and submit Medicare and Medicaid enrollment applications accurately and timely
- Serve as a primary point of contact for providers regarding credentialing status, required documentation, and outstanding items
- Maintain accurate provider information within credentialing software, files, and tracking systems
- Communicate with state agencies, licensing boards, CMS, and other external organizations to obtain or verify provider information
- Support credentialing-related audits, inquiries, and requests for information
- Partner with Human Resources, Compliance, and Clinical Operations to support a smooth provider onboarding and credentialing experience
- Identify and help resolve credentialing issues in a timely and professional manner
- Prepare and maintain reports related to credentialing status, turnaround times, and other key metrics
- Maintain confidentiality of provider information in accordance with HIPAA and organizational requirements
Requirements:
- High school diploma or equivalent required; associate or bachelor’s degree in Healthcare Administration, Business, or a related field preferred
- 1–3 years of experience in healthcare credentialing, facility credentialing, payer enrollment, compliance, or healthcare administration preferred
- Experience with facility-level credentialing and enrollment strongly preferred
- Experience completing and maintaining Medicare and Medicaid enrollment applications and working with commercial payers preferred
- Experience supporting credentialing or enrollment for healthcare facilities, locations, branches, or organizations, rather than solely individual provider credentialing, preferred
- Familiarity with healthcare regulatory requirements, HIPAA, accreditation standards, and payer requirements
- Experience working with CMS, state Medicaid programs, insurance payers, licensing agencies, or other regulatory entities preferred
- Ability to track multiple applications, renewals, licenses, certifications, deadlines, and outstanding documentation simultaneously
- Strong attention to detail with the ability to identify missing or inconsistent information and follow items through to resolution
- Strong written and verbal communication skills with the ability to work effectively with payers, regulatory agencies, internal leaders, and operational teams
- Strong organizational and time-management skills with the ability to independently manage competing priorities in a remote, fast-paced environment
- Proficiency with Microsoft Office and experience with credentialing, enrollment, or healthcare management systems
- Demonstrated accountability, responsiveness, and consistent follow-through
- Facility credentialing and payer enrollment experience preferred
- Experience credentialing or enrolling multiple healthcare locations, facilities, or branches across multiple states preferred
- Experience with Medicare, Medicaid, and commercial payer enrollment preferred
- Experience supporting credentialing audits, renewals, and regulatory requests preferred
- Experience within home healthcare, DME, pediatric healthcare, or another multi-location healthcare organization preferred
Benefits:
- Generous Paid Time Off (PTO) for full-time employees to support a healthy work-life balance
- 401(k) Matching to help secure your future
- Tuition Reimbursement to support your educational and professional growth
- Professional Development & Learning Opportunities
- Health and Dental Insurance
- Short & Long Term Disability and Life Insurance
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