Provider Enrollment, Credentialing Specialist

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🕒 June 25

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Total Life

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2020

🏥 Healthcare

💼 Consulting

🛡️ Insurance

💰 Seed Round on 2022-01

Healthcare • Consulting • Insurance

Total Life is an online therapy service specifically designed for seniors. The company provides mental health counseling and therapy through virtual means, making access to support easy and convenient for older adults, particularly those covered by Medicare. Total Life offers personalized care through experienced therapists licensed to work in seniors' states, focusing on conditions such as anxiety, depression, cognitive decline, and chronic pain. Their services include individual, group, family, and couples therapy, ensuring comprehensive support tailored to seniors’ needs, often covered by Medicare to reduce financial burden.

📋 Description

• 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

• 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.