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Credentialing Coordinator
Pediatric Home Service. Coordinate provider credentialing and recredentialing processes in accordance with regulatory requirements and organizational standards .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare credentialing processes, including Medicare and Medicaid enrollment, while ensuring compliance with regulatory requirements and maintaining accurate provider information. Strong organizational and communication skills are essential for managing multiple applications and collaborating with various stakeholders.
Highest-signal resume keywords
Healthcare Credentialing ExperienceMedicare And Medicaid EnrollmentRegulatory Compliance KnowledgeAttention To DetailMicrosoft Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Credentialing ProcessesProvider Documentation VerificationLicense And Certification TrackingEnrollment Application CompletionCredentialing Software ManagementAudit SupportHealthcare AdministrationPayer EnrollmentRegulatory Requirements FamiliarityMulti-Location Credentialing
Soft Skills
Strong Communication SkillsOrganizational SkillsTime ManagementProblem-SolvingResponsiveness
Tools & Technologies
Credentialing SoftwareHealthcare Management SystemsTracking Systems
Industry Keywords
HIPAA ComplianceAccreditation StandardsCMSState Medicaid ProgramsInsurance PayersLicensing AgenciesHome HealthcareDMEPediatric Healthcare
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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