Provider Enrollment & Licensing Specialist

Abricare, Inc.

19d•Remote

About The Position

The Provider Enrollment & Licensing Specialist plays a critical role in ensuring AbriCare maintains the highest standards of regulatory, licensing, and payer compliance across all states where we operate and expand. This individual manages the full lifecycle of agency credentialing, state provider enrollment, payer onboarding, documentation maintenance, and renewal processes. By ensuring AbriCare remains fully credentialed and audit-ready, the Credentialing Specialist enables service continuity, timely market launches, and smooth payer operations. This role partners closely with Operations, Clinical, People, and Growth teams, supporting both day-to-day compliance and long-term multi-state expansion.

Requirements

High school diploma or GED required; associate’s or bachelor’s degree preferred (healthcare administration, business, or related field).
Minimum of 2 years of experience in healthcare credentialing, provider enrollment, compliance administration, or medical operations.
Strong working knowledge of Medicaid, waiver programs, MCO credentialing, or long-term care provider enrollment.
Exceptional organizational skills with a high degree of accuracy and attention to detail.
Proficiency in Microsoft Office and comfort navigating multiple digital systems, including payer portals, HRIS, LMS, and EMRs.
Ability to manage complex processes, multiple deadlines, and cross-functional communication.
Demonstrated ability to work independently and collaboratively within a remote or distributed team environment.

Nice To Haves

Experience with credentialing in home care, PCS, HCBS, or long-term services and supports (LTSS).
Familiarity with Medicaid waiver programs, APC requirements, and RN supervisory documentation.
Background in multi-state credentialing or rapid-growth healthcare organizations.

Responsibilities

Manage all credentialing activities required for AbriCare to operate as a licensed and approved PCS provider across multiple states.
Maintain a master calendar of state requirements, renewal deadlines, addendum expirations, and required compliance submissions.
Track and organize documents required for new market launches, ensuring all credentialing milestones are completed on schedule.
Complete credentialing and re-credentialing with Medicaid, Managed Medicaid (MCOs), VA, AAAs, long-term care insurance, and D-SNP plans.
Maintain accurate payer records including NPIs, taxonomy codes, service types, and authorized care models.
Monitor payer portals for updates, expiring documents, roster reconciliation requests, and required compliance attestations.
Resolve credentialing gaps proactively to prevent delays in billing, reimbursement, or service initiation.
Support onboarding and compliance verification for caregivers and clinical team members, ensuring all required documentation is completed and kept current.
Ensure personnel files meet state standards and are audit-ready at all times.
Maintain centralized, secure credentialing files with strict version control and real-time accuracy.
Implement and manage credentialing trackers within AbriCare’s HRIS, LMS, EMR, and operational systems.
Ensure credentialing related policies, addenda, and state-specific regulatory documents are up-to-date and accessible to relevant teams.
Prepare and organize documentation for state audits, waiver program reviews, payer surveys, and QAPI reporting.
Serve as a point of contact for credentialing-related inquiries during audits, site visits, or investigations.
Partner with Operations and Clinical teams to ensure credentialing completion aligns with service readiness in each market.
Support Growth and Intake teams by ensuring payer credentialing is completed before client onboarding begins.
Work closely with People Operations to align caregiver onboarding requirements with state and payer compliance needs.