Credentialing Coordinator

Pediatric Home Service, Inc.; Roseville (MN); Hybrid; USD 33,000 - 36,000; Full time

Benefits offered by this job

Paid Time Off

401(k) Matching

Tuition Reimbursement

Health and Dental Insurance

Short & Long Term Disability and Life

Job summary

Pediatric Home Service, Inc. is seeking an organized Credentialing Coordinator to manage credentialing and enrollment for facilities and locations.

You will verify documentation, ensure regulatory compliance, and collaborate with payers, regulators, and internal teams to support enrollment and revalidation across multiple sites. The role emphasizes accuracy, timely processing, and proactive resolution of issues to maintain payer participation and operational readiness in a fast-paced healthcare

Qualifications

• High school diploma or equivalent required; Associate or bachelor’s degree in Healthcare Administration, Business, or related field preferred
• One (1) year of experience in healthcare credentialing, facility credentialing, payer enrollment, compliance, or healthcare administration
• Experience supporting credentialing or enrollment for healthcare facilities, locations, branches, or organizations, preferred
• Familiarity with healthcare regulatory requirements, HIPAA, accreditation standards, and payer requirements
• Experience working with CMS, state Medicaid programs, insurance payers, licensing agencies, or regulatory entities preferred
• Ability to track multiple applications, renewals, licenses, certifications, deadlines, and outstanding documentation simultaneously
• Strong written and verbal communication skills; able to work with payers, regulatory agencies, internal leaders, and teams
• Strong organizational and time-management skills for a remote, fast-paced environment
• Proficiency with Microsoft Office and credentialing/enrollment systems

Responsibilities

• Coordinate facility/entity credentialing, enrollment, recredentialing, and revalidation activities in accordance with payer, federal, state, county, city, and organizational requirements
• Collect and maintain facility licenses, certifications, permits, inspections, accreditations, ownership information, NPIs, TINs, and other enrollment documentation
• Complete and submit facility/entity enrollment applications for Medicare, Medicaid, and commercial payers accurately and timely
• Manage enrollment and credentialing activities for new entities, new locations, ownership changes, revalidations, and demographic updates
• Track licenses, certifications, permits, payer enrollments, revalidations, and credential expiration dates to ensure ongoing compliance
• Serve as the primary contact for internal stakeholders regarding credentialing and enrollment status, required docs, outstanding items, and effective dates
• Maintain data in credentialing software, payer portals, files, and tracking systems
• Communicate with CMS, state Medicaid, commercial payers, licensing agencies, and regulatory bodies to obtain information and resolve deficiencies
• Follow up on pending applications and resolve enrollment/credentialing issues affecting payer participation or operations
• Support audits, site inspections, and information requests with accurate documentation
• Collaborate with Real Estate, Compliance, Clinical Operations, Revenue Cycle, and other teams for new facilities or changes
• Prepare and maintain reports on credentialing status, payer enrollment, aging, renewals, and dates
• Maintain confidentiality per HIPAA and regulatory policies

Skills

Attention to detail

Communication skills

Organizational skills

Time management

Microsoft Office

Education

High school diploma or equivalent

Associate or bachelor’s degree in Healthcare Administration or related field preferred

Tools

Microsoft Office

Credentialing software

Job description

Working for Pediatric Home Service means making a difference. It means having a positive impact on the medically complex patients in your community. It also means joining a pretty fabulous team of individuals. We take our work and our fun seriously.

At Pediatric Home Service, we help medically complex kids live their best lives, at home, with their families. As a national leader in pediatric home care, we offer a full range of services including infusion, clinical nutrition, respiratory therapy, PPEC, private duty nursing, and DME. Whether you're caring for patients or supporting behind the scenes, every role at PHS makes a difference. Join a mission-driven team that’s committed to putting children and families first.

• Focus on Compliance / Facilities Licensing
• Location: Remote - Open to Minnesota or Kansas
• Hours: Monday-Friday, 8:00 AM - 5:00 PM

We're looking for an organized and detail-oriented Credentialing Coordinator to join our team! In this role, you'll help manage the credentialing and recredentialing process for our facilities and locations, ensuring information is accurate, complete, and compliant with applicable requirements.

You’ll work closely with internal teams, payers, government agencies, and regulatory organizations to support the credentialing, enrollment, and ongoing compliance of our healthcare entities and facility locations. You’ll collect and verify facility documentation, manage commercial payer, Medicare, and Medicaid enrollment applications, monitor licenses and certifications, coordinate revalidations, and help ensure each entity and location maintains the credentials necessary to operate and participate with payers.

This is a great opportunity for someone with facility or organizational credentialing experience who enjoys staying organized, solving enrollment and regulatory issues, and managing multiple locations and priorities in a fast-paced healthcare environment.

• Coordinate facility/entity credentialing, enrollment, recredentialing, and revalidation activities in accordance with payer, federal, state, county, city, and organizational requirements
• Collect, review, and maintain facility-level documentation, including licenses, certifications, permits, inspections, accreditations, ownership information, organizational NPIs, TINs, and other documentation required for enrollment and regulatory compliance
• Complete and submit facility/entity enrollment applications for Medicare, Medicaid, and commercial payers accurately and within required timeframes
• Manage enrollment and credentialing activities associated with new entities, new facility locations, location changes, ownership changes, revalidations, and other demographic updates
• Track facility licenses, certifications, permits, payer enrollments, revalidations, and other credential expiration or renewal dates to help ensure continuous compliance
• Serve as a primary point of contact for internal stakeholders regarding facility credentialing and enrollment status, required documentation, outstanding items, and effective dates
• Maintain accurate facility, entity, location, payer, and regulatory information within credentialing software, payer portals, files, and tracking systems
• Communicate with CMS, state Medicaid agencies, commercial payers, state licensing agencies, city and county agencies, and other regulatory organizations to obtain information, resolve deficiencies, and verify facility enrollment or credentialing requirements
• Follow up on pending applications and proactively identify and resolve facility enrollment, credentialing, licensing, and revalidation issues that could affect payer participation or operational readiness
• Support facility credentialing and regulatory audits, inquiries, site inspections, and requests for information, ensuring documentation is accurate, complete, and readily available.
• Partner with Real Estate, Compliance, Clinical Operations, Revenue Cycle, and other internal teams to support new facility openings, changes to existing locations, and ongoing credentialing requirements
• Prepare and maintain reports related to facility credentialing status, payer enrollment, application aging, upcoming renewals/revalidations, effective dates, and other key metrics.
• Maintain confidentiality and ensure facility and organizational information is handled in accordance with HIPAA, regulatory requirements, and organizational policies

Qualifications:

• High school diploma or equivalent required; Associate or bachelor’s degree in Healthcare Administration, Business, or a related field preferred
• One (1) year of experience in healthcare credentialing, facility credentialing, payer enrollment, compliance, or healthcare administration
• 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

Preferred:

• Facility credentialing and payer enrollment experience strongly preferred
• Experience credentialing or enrolling multiple healthcare locations, facilities, or branches across multiple states
• Experience supporting credentialing audits, renewals, and regulatory requests
• Experience within home healthcare, DME, pediatric healthcare, Pediatric Prescribed Extended Care (PPEC) or another multi-location healthcare organization
• 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

Salary Range:

At PHS, we are committed to providing specialized care for medically complex children. Every role, from direct patient care to customer support, plays a vital part in improving the lives of kids and families. The impact you make is invaluable. We are dedicated to offering fair and transparent compensation to our team members. The range for this role for candidates located in the Minneapolis, MN area is $23.70 to $26.07 hourly, based on experience and qualifications.

We look forward to learning more about you & the skills you can bring to Pediatric Home Service!

Pediatric Home Service is an equal opportunity employer; we are committed to affirmative action and equal employment opportunities for all regardless of protected veteran status, race, color, creed, religion, national origin, sex, sexual orientation or identity, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance.

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