ALTCS & MCO Credentialing Specialist

Role Purpose

The ALTCS & MCO Credentialing Specialist is responsible for managing and maintaining provider credentialing, enrollment, and revalidation with Arizona Long Term Care System (ALTCS) plans and Managed Care Organizations (MCOs). This role ensures continuous compliance, accurate provider data, and uninterrupted reimbursement for home care and assisted living services.

• Complete initial credentialing and re-credentialing for ALTCS and contracted MCOs (e.g., Mercy Care, Banner, United Healthcare, Molina, Dignity Health, etc.)
• Manage provider enrollment for agencies, facilities, and individual caregivers as applicable
• Track credentialing timelines, expirations, and revalidation cycles
• Maintain accurate CAQH and payer portal profiles

• Ensure licenses, insurance, certifications, and compliance documents remain current
• Coordinate with operations and HR on caregiver and provider onboarding documentation
• Maintain organized digital credentialing files and audit‑ready records

• Serve as primary contact with MCO credentialing departments
• Follow up on applications, corrections, and status updates
• Resolve credentialing delays that impact claims or authorizations

• Support state and payer audits as needed
• Generate credentialing status reports for leadership
• Proactively identify risks to credentialing continuity

• Standardize credentialing workflows and checklists
• Recommend automation or system improvements for scale

• 2+ years of experience with Arizona ALTCS and/or MCO credentialing
• Strong familiarity with the Arizona Medicaid managed care environment
• Experience with payer portals and credentialing systems
• High attention to detail and strong follow‑up discipline
• Ability to work independently and manage deadlines

• Home health, home care, assisted living, or healthcare services background
• CAQH maintenance experience
• Compliance or audit support experience
• Familiarity with Arizona AHCCCS processes