Total Life · 9 hours ago
Provider Enrollment & Credentialing Specialist
United States
Full-time
Remote
Entry, Mid Level
$50K/yr - $70K/yr
2+ years expTotal Life is a behavioral health company dedicated to improving the mental health of the 65+ population. The Provider Enrollment & Credentialing Specialist plays a crucial role in ensuring that clinicians are properly vetted and licensed to provide care, while managing the complexities of insurance enrollment and compliance.
Elder CareElectronic Health Record (EHR)Health DiagnosticsInformation TechnologymHealthOutpatient CarePersonal HealthSoftwareWellness
Responsibilities
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
Qualification
Required
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
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
Company
Total Life
Total Life is rethinking aging making it easy for seniors on Medicare to access clinical wellness and mental fitness services online.
11-50 employees
Funding
Current Stage
Early StageTotal Funding
$1.5M2022-01-31Seed· $1.5M
Recent News
EIN Presswire
2025-10-17
2024-12-16
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