Provider Enrollment, Credentialing Specialist

Total Life

Provider Enrollment & Credentialing Specialist at Total Life ensuring qualified clinicians for senior mental health care. Manage credentialing processes and collaborate with internal teams to maintain compliance.

Posted 6/25/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $50,000 - $70,000 per yearWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

provider credentialingenrollment applicationsbackground checksdata entrycompliance standardscredentialing requirementslicense verificationprovider data maintenanceclaim resolution

Soft Skills

communicationaccuracycollaborationattention to detailproblem-solving

Tools & Technologies

CAQH ProViewPECOSNPPESTLOSHealthycredentialing softwareEHR platforms

Certifications & Qualifications

Certified Provider Enrollment Specialist (CPES)Certified Professional Credentialing Specialist (CPCS)

Industry Keywords

MedicareMedicaidbehavioral healthtelehealthNCQACMSLCSWPsychologistsmalpractice insuranceinsurance panels

About the role

Key responsibilities & impact

Manage the collection, verification, and maintenance of all provider credentials, including professional licenses, board certifications, DEA registrations, and malpractice insurance.
Oversee the submission and tracking of enrollment applications for Medicare (PECOS), Medicaid, and commercial insurance panels (e.g., Humana).
Maintain and update provider profiles in the CAQH ProView database, ensuring timely re-attestations every 120 days.
Conduct thorough background checks and verify education, training, and work history to ensure compliance with NCQA and CMS standards.
Update and maintain accurate provider data within internal systems (TLOS and Healthy) to ensure the Active Care team has real-time visibility into provider capacity and expertise.
Proactively monitor and notify clinicians of upcoming license or certification expirations to prevent gaps in service or billing.
Collaborate with the Revenue Cycle Management (RCM) team to resolve claim denials related to provider credentialing or enrollment issues.

Requirements

What you’ll need

2–6 years of experience in provider credentialing or enrollment, preferably within a behavioral health or telehealth organization.
Demonstrated experience with the PECOS, NPPES (NPI), and CAQH portals.
Deep understanding of the credentialing requirements for LCSWs, Psychologists, and other mental health professionals.
Familiarity with the licensing boards and enrollment timelines for all US states
Exceptional accuracy in data entry and a "compliance-first" mindset.
Ability to communicate clearly and professionally with clinicians, insurance representatives, and internal stakeholders.
Certified Provider Enrollment Specialist (CPES) or Certified Professional Credentialing Specialist (CPCS).
Experience with credentialing software and EHR platforms.

Benefits

Comp & perks

Executive Partnership: Direct partnership with executive leadership to influence strategy, processes, and financial performance at an enterprise level.
Competitive Package: Competitive compensation and benefits package.
Purpose-Driven Work: The ability to influence the financial health of a movement dedicated to the mental wellness of the 65+ population.
Premium Medical, Dental, and Vision insurance plans for you and your dependents.