Compliance Manager, Servicios Médicos

Puesto: COMPLIANCE MANAGER
Provider Enrollment, Licensing & Credentialing Specialist

** Responsibilities:*
* - Manage end-to-end state licensing, credentialing, Medicaid and Medicare enrollment, insurance applications, and regulatory documentation for home care, home health, and hospice agencies.
- Supervise the execution and administration of all Provider Enrollment contracts.
- Support Sales team with commercial calls, contract review and issuance.
- Address and resolve client inquiries, complaints, investigations, and clarifications.
- Act as Application Traffic Coordinator.
- Prepare and oversee monthly reports including Financial Liability Report, Application Tracker, and Submission/Approval Reports.
- Handle state-specific issues with Ombudsman Offices and State Supervisors/Directors.
- Draft and update Medicaid Waiver application policies and procedures.
- Conduct state and program regulatory research to support internal teams and sales.
- Review and prepare Corrective Action Plans and required state authority documentation.
- Complete licensing, credentialing, and provider enrollment applications fully.
- Process documentation accurately on state and agency portals.
- Communicate with clients to gather required documentation per state.
- Stay updated on state regulations and insurance program requirements.
- Maintain application documentation, requirements, and status in CRM and trackers.
- Review applications to ensure completeness and accuracy before submission.
- Educate clients on timelines, requirements, and expectations throughout processes.
- Prioritize and manage incoming customer calls.
- Enter new contracts into CRM (Nutshell).
- Scan, upload, and organize client documents on Shared Drive.
- Create, audit, and correct monthly reports.
- Process application cancellations and termination agreements.
- Manage emails and reception tasks.
- Provide support with copying, faxing, mailing, and internal meetings.

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* Schedule:

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* - Monday to Friday
- 8:00 AM – 6:00 PM (EST)

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* Education & Experience:

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* - High school diploma or GED.
- 1 to 2 years of experience in licensing, credentialing, provider enrollment, compliance, or legal research.
- Experience in home care, home health, or hospice sectors.
- Proven ability to manage high volume caseloads and meet deadlines.
- Knowledge of regulatory research or state compliance is a plus.

** Technical

Skills:

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* - Proficient with Microsoft 365 and Microsoft Office.
- Intermediate Adobe Acrobat skills.

- Experience with CRM systems (Nutshell preferred; Salesforce desirable).
- Strong research skills in state government portals.
- Ability to quickly learn new systems and workflows.
- Experience documenting processes and maintaining detailed trackers.

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* Soft Skills:

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* - High attention to detail and organizational skills.
- Excellent written and verbal communication in English.
- Customer service oriented with professional demeanor.
- Ability to interpret complex regulations and guidelines.
- Logical thinking and strong problem-solving skills.
- Ability to work independently and collaboratively.
- Resilience in fast-paced, high-volume environments.