Credentialing Coordinator

Summary

Pediatric Home Service is a national pediatric home care provider helping medically complex children live at home with their families. The Credentialing Coordinator manages provider credentialing and recredentialing, documentation verification, Medicare and Medicaid enrollment, expiration tracking, audits, and coordination with internal teams and external regulatory organizations.

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

Skills

• High school diploma or equivalent required
• Familiarity with healthcare regulatory requirements, HIPAA, accreditation standards, and payer requirements
• 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
• 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
• Experience working with CMS, state Medicaid programs, insurance payers, licensing agencies, or other regulatory entities preferred
• Facility credentialing and payer enrollment experience
• Experience credentialing or enrolling multiple healthcare locations, facilities, or branches across multiple states
• Experience with Medicare, Medicaid, and commercial payer enrollment
• Experience supporting credentialing audits, renewals, and regulatory requests
• Experience within home healthcare, DME, pediatric healthcare, or another multi-location healthcare organization

Qualifications

Must Haves

• High school diploma or equivalent required
• Familiarity with healthcare regulatory requirements, HIPAA, accreditation standards, and payer requirements
• 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

Nice to Haves

• 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
• Experience working with CMS, state Medicaid programs, insurance payers, licensing agencies, or other regulatory entities preferred
• Facility credentialing and payer enrollment experience
• Experience credentialing or enrolling multiple healthcare locations, facilities, or branches across multiple states
• Experience with Medicare, Medicaid, and commercial payer enrollment
• Experience supporting credentialing audits, renewals, and regulatory requests
• Experience within home healthcare, DME, pediatric healthcare, or another multi-location healthcare organization

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
• Fully Remote