Provider Enrollment, Credentialing Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the collection, verification, and upkeep of all provider credentials, which includes professional licenses, board certifications, DEA registrations, and malpractice insurance.

• Manage the submission and tracking of enrollment applications for Medicare (PECOS), Medicaid, and various commercial insurance panels (e.g., Humana).

• Regularly maintain and update provider profiles in the CAQH ProView database, ensuring timely re-attestations every 120 days.

• Perform comprehensive background checks and validate education, training, and work history to ensure adherence to NCQA and CMS standards.

• Keep accurate provider data in internal systems (TLOS and Healthy) to provide the Active Care team with real-time insights into provider capacity and expertise.

• Actively monitor and inform clinicians of impending license or certification expirations to avert service or billing interruptions.

• Work in conjunction with the Revenue Cycle Management (RCM) team to address claim denials related to provider credentialing or enrollment concerns.

⛳️ Requirements

• 2–6 years of experience in provider credentialing or enrollment, ideally within a behavioral health or telehealth organization.

• Proven experience with the PECOS, NPPES (NPI), and CAQH portals.

• Comprehensive understanding of the credentialing requirements for LCSWs, Psychologists, and other mental health professionals.

• Knowledge of the licensing boards and enrollment timelines across all US states.

• Exceptional attention to detail in data entry and a strong "compliance-first" approach.

• Ability to communicate effectively and professionally with clinicians, insurance representatives, and internal stakeholders.

• Certified Provider Enrollment Specialist (CPES) or Certified Professional Credentialing Specialist (CPCS).

• Familiarity with credentialing software and EHR platforms.

🏝️ Benefits

• Executive Partnership: Direct collaboration with executive leadership to shape strategy, processes, and financial performance at an enterprise level.

• Competitive Package: Attractive compensation and benefits package.

• Purpose-Driven Work: Opportunity to impact the financial health of a movement committed to the mental wellness of the 65+ population.

• Comprehensive Medical, Dental, and Vision insurance plans for you and your dependents.