Licensing and Credentialing Specialist
Ophelia
Administration
United States
Posted on Nov 12, 2024
Ophelia is a venture-backed healthcare startup that helps individuals with OUD improve their health and quality of life. We make medical best practices for OUD discreet, convenient, and affordable by providing FDA-approved medication, support, and therapy through a telehealth platform. Our mission is to help patients manage their OUD by using evidence-based MAT, technology, and a commitment to patient privacy and choice.
We are a team of doctors, scientists, startup veterans, and White House advisors, backed by leading technology and healthcare investors working to re-imagine and re-build OUD treatment in America.
Join us, save lives, and help fix healthcare for those who need it most.
The Role
The Licensing and Credentialing Specialist helps us achieve our Mission by ensuring our clinicians are properly credentialed, licensed, and enrolled in payor networks to care for our patients. The responsibilities include timely submission of new and renewal licensing requests, credentialing of Ophelia’s providers, and the enrollment of Physicians, Nurse Practitioners, and Physician Assistants in managed care organizations and government payors such as Medicare and Medicaid, as well as many commercial plans. The L&C Specialist also maintains accurate provider records within various databases, including CAQH and payer portals.
The L&C Specialist works with a team of other specialists and collaborates closely with Clinical Operations, Billing, and Contracting teams to ensure our patient care functions smoothly. The role reports to the Licensing and Credentialing Manager.
In this role, you will:
- Review provider initial and reappointment credentialing applications, ensuring compliance with industry standards.
- Conduct primary source verification and coordinate the credentialing committee review process
- Ensure new and renewed license, DEA, and CSR requests are submitted promptly
- Follow up directly with providers to gather missing or incomplete information for enrollment submissions.
- Submit enrollment packets to payers (MCOs, Medicare, Medicaid) in an accurate and timely manner.
- Monitor enrollment status and address any delays by following up with payers to expedite credentialing approvals.
- Enter and maintain accurate provider enrollment data in internal and external databases, including CAQH and payer portals, by updating demographic information, practice locations, termination of providers, and other maintenance forms as required.
- Act as a point of contact between providers, payors, and internal teams to resolve issues related to credentialing, enrollment, and reimbursement.
What we're looking for:
- Associates degree or equivalent combination of education and/or experience
- 3-5 years of working experience in a credentialing and enrollment setting required
- Knowledge of multi-state/national provider credentialing and/or enrollment required
- Experience with PECOS/Medicare and/or state Medicaid enrollment platforms
- Knowledge of Google Workplace/Microsoft office or other task management suites
- National Association of Medical Staff Services (NAMSS) Certified Provider Credentialing Specialist (CPCS) certification a plus
Our benefits include:
- Generous health care coverage (Blue plans + Kaiser in California) - many plans are fully covered for the employee!
- Up to 4 weeks of PTO annually (no waiting period) and 10 company holidays
- 401k contribution platform
- Remote-first work environment
- $1,000 work-from-home stipend
- Life insurance, short and long term disability
- Additional benefits offered through our benefits provider such as life insurance, short and long term disability, financial wellness, virtual primary care, among others!
- A meaningful mission and humble, fun colleagues: a work environment that is respectful, collaborative, and driven
#LI-Remote
