Senior Licensing and Compliance Specialist

Description

Payer Relations: Senior Licensing and Compliance Specialist

General Job Description

Reports to: Senior Manager Payer Relations

Position Summary: The Senior Licensing Specialist is responsible for overseeing and executing complex provider licensing activities across multiple states and specialties. This role ensures full compliance with regulatory requirements, drives process efficiency, and serves as a subject matter expert for internal teams, providers, and external agencies. The Senior Licensing Specialist works with a high degree of independence and is accountable for maintaining accurate, timely, and audit ready licensing records.

Measures Of Success

100% of provider licenses renewed on time, with no lapses in active licensure.

• Licensing files maintained at 98–100% accuracy, verified through monthly internal audits.
• All licensing suites and digital records kept fully updated, with required documents uploaded within 2 business days of receipt.
• Renewal workflows initiated at least 45-60 days before expiration, ensuring proactive compliance.
• Turnaround time for renewals and updates consistently meets or exceeds departmental SLAs.
• Zero compliance findings related to licensing documentation during internal or external audits.
• Clear, timely communication with providers and internal teams, demonstrated by meeting response‑time expectations.
• Process improvements identified and implemented quarterly to enhance efficiency, accuracy, or compliance.
  
  

Primary Duties

Licensing & Compliance

• Manage end‑to‑end provider licensing processes, including initial applications, renewals, reinstatements, and jurisdiction‑specific requirements.
• Interpret state board regulations and ensure all licensing activities meet federal, state, and organizational standards.
• Maintain accurate, up‑to‑date records in internal systems and external portals.
• Monitor expiration dates and proactively initiate renewal workflows to prevent lapses in licensure.
• Communicate professionally with providers regarding requirements, timelines, and outstanding items.
• Coordinate with credentialing, enrollment, HR, and onboarding teams to ensure seamless provider activation.
• Build strong relationships with state boards, vendors, and external partners.
  
  

Data & Reporting

• Track licensing metrics, turnaround times, and compliance indicators.
• Prepare reports for leadership and contribute to performance dashboards.
• Ensure data integrity across all systems and documentation repositories.
• Serve as the primary escalation point for complex licensing issues, delays, or regulatory barriers.
• Maintain expert‑level knowledge of state medical boards, facility licensing rules, and regulatory changes.
• Partner with leadership to support compliance initiatives, accreditation requirements, and internal audits.
• Contribute to performance dashboards and operational reporting.
• Other duties as assigned.
  
  

Competencies

Must be able to speak, read, and write fluent English.

Exceptional human relation skills

Ability to manage multiple priorities with interruptions

Ability to work with people of all ages

Ability to use correct grammar, spelling, and punctuation

Ability to always maintain professional demeanor

Ability to understand the dynamic, changing insurance industry

Ability to resolve conflict

Ability to complete tasks within the required time frame

Ability to write legibly and clearly

Compliance with all federal, state, and local regulatory laws and licensing requirements

USOSM (and its affiliates) is an equal opportunity employer and do not discriminate on the basis of race, color, gender, religion, age, sexual orientation, national or ethnic origin, disability, marital status, veteran status, or any other occupationally irrelevant criteria. All locations are smoke-free environments and as such, prohibit smoking in all facilities. This s a drug-free workplace. Employment is on an “at-will” basis and is for no definite period and may, regardless of the date or method of payment of wages and salary, be terminated at any time with and without cause. No person, irrespective of title or position, has authority to alter the at-will status of your employment or to enter into any employment contract for a definite period of time with you.