Provider Enrollment, Credentialing Specialist

Job 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.