Our Provider Licensing and Enrollment Specialist plays a vital role in ensuring our healthcare providers can focus on delivering exceptional care. This position manages licensing processes across all 50 states, Medicaid and Medicare plan enrollments, and regulatory compliance with precision and care. The specialist collaborates with internal teams and external agencies to streamline processes, maintain accuracy, and stay ahead of evolving Medicaid, Medicare, and credentialing requirements. With a focus on innovation and efficiency, the role drives our expansion efforts while safeguarding compliance standards in a fast-paced, mission-driven environment.

Ideal candidates bring startup experience, a strong understanding of healthcare regulations, and a passion for solving complex challenges. They are detail-oriented, thrive in collaborative environments, and excel in managing critical processes to make a meaningful impact. 

This is a full time, remote, home-office based role eligible for a full benefits package including paid holidays, PTO, and competitive pay in a mission-based work environment. A private, quiet, home office space is required. Candidates can live anywhere in the United States.

About Blue Circle Health:

Blue Circle Health is a 501(c)(3) nonprofit organization dedicated to improving the health of people with type 1 diabetes (T1D), a chronic autoimmune condition in which the body doesn’t produce insulin. T1D affects more than 2 million people in the US, and many face barriers to the care, education, medication, and supplies needed to manage their condition. 

Blue Circle Health provides virtual care, education, and support for adults with T1D, at no cost to them. Because T1D is a 24/7 condition that is largely self-managed, we educate and empower people with T1D to ensure they have the skills, tools, and confidence to manage their condition. Our whole-person approach includes medical care, diabetes education, peer coaching, diabetes supportive counseling, insurance navigation, supplies and medication, and referrals to community resources that can help with access to housing, employment and food.

Funded by the Leona M. and Harry B. Helmsley Charitable Trust, we are building a high-quality virtual healthcare delivery and support model for people with T1D. We partner with patient advocacy groups, health systems and clinics, including Federally Qualified Health Centers, to reach people with T1D. We aim to show that our model can be replicated for other chronic conditions to improve health outcomes and reduce the burden on the US healthcare system. 

We’re seeking mission-driven professionals to help us create a  healthcare delivery and support model that people deserve. 

Core Responsibilities:

• Handle clinical licensing applications and renewals, initial plan enrollment and revalidation processes for healthcare providers such as physicians, nurse practitioners, licensed clinical social workers, and registered dietitians.
  • Ensure provider enrollment policies and procedures are efficient and compliant with Medicaid and Medicare regulations.
• Collect, analyze, and evaluate provider-specific information to meet the requirements of licensing boards and government plans.
  • Stay updated on evolving regulations, standards, and procedures to maintain compliance with national regulatory standards.
• Maintain effective communication with internal teams, including individual providers, clinical staff, IT, administration, and finance departments.
  • Collaborate externally with licensing vendors, licensing boards, payor credentialing departments, and government agencies (e.g., CMS).
• Maintain organized and up-to-date provider files to serve as official records and ensure accuracy in the event of discrepancies.
• Identify opportunities for performance improvement in the enrollment and licensing processes. Recommend and implement strategies to enhance operational efficiency.
• Monitor unresolved issues, provide regular updates through reporting, and escalate matters to management as needed.
  

Expected Capabilities:

• 3 or more years experience working in healthcare licensing, credentialing or provider enrollments. 
• Startup or experience with national or multi-state healthcare organizations is ideal.
• Deep understanding of Medicaid and Medicare enrollment requirements, as well as licensing board standards and government procedures. Familiarity with payor credentialing and regulatory compliance.
• Ability to gather, analyze, and evaluate information for accurate decision-making. Proficiency in identifying and implementing solutions to streamline processes.
• Demonstrated ability to maintain accurate and well-organized records. Keen attention to detail to ensure compliance and prevent discrepancies.
• Excellent written and verbal communication skills to interact effectively with internal and external stakeholders. Collaborative mindset to work with diverse teams and external agencies.
• High degree of independence to manage responsibilities and make sound decisions. Ability to discern when to escalate issues to management.
• Flexibility to adapt to changing regulatory environments and organizational priorities. Proactive approach in identifying performance improvement opportunities.
• Must maintain a high level of confidentiality at all times.

Compensation & Benefits:

• The pay range for this role is $26-$32/hour. This is the pay range we reasonably expect to pay for this position. Individual compensation decisions are based on a variety of factors. 
• Health + dental + vision + short & long term disability coverage.
• 401(k)
• PTO & Holidays
• 100% remote work within the United States with much of the current organization located in the Eastern time zone. Attendance at occasional in-person meetings may be required.
• Opportunity to shape a healthcare delivery system and contribute to strategy every step of the way.
• Make an impact in the lives of patients at a non-profit dedicated to improving healthcare.

Anticipated Job Posting Close Date:

January 13, 2025. Applications will be reviewed as they are received.

We are an equal opportunity employer and do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.