Full-Time

Licensing and Credentialing Specialist

Updated on 12/3/2024

Ophelia

Ophelia

201-500 employees

Provides medication-assisted treatment for opioid dependence

Social Impact
Healthcare

Compensation Overview

$55k - $60kAnnually

Mid

Remote in USA

Category
Risk & Compliance
Legal & Compliance
Requirements
  • 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
Responsibilities
  • 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.

Ophelia provides medication-assisted treatment (MAT) for individuals dealing with opioid dependence. Their approach focuses on helping patients manage cravings and withdrawal symptoms through scientifically-backed treatments, which are designed to be more private and convenient than traditional rehab methods. Ophelia differentiates itself from competitors by offering a modern, patient-centric model that emphasizes discretion and empowerment, allowing patients to make informed choices about their treatment. The company's goal is to reduce the stigma surrounding drug rehabilitation and to provide effective alternatives that cater to a diverse clientele, particularly those under 50 who are at higher risk of opioid overdose.

Company Stage

Series B

Total Funding

$65.9M

Headquarters

Philadelphia, Pennsylvania

Founded

2020

Growth & Insights
Headcount

6 month growth

25%

1 year growth

45%

2 year growth

33%
Simplify Jobs

Simplify's Take

What believers are saying

  • Ophelia's recent $50 million Series B funding round, led by Tiger Global, positions the company for national expansion and integration with additional payors and partners.
  • The company's collaboration with Highmark Wholecare and MVP Healthcare expands access to life-saving MAT for over 600,000 people, highlighting its growth potential.
  • Ophelia's leadership team, with new hires from Babylon Health and Omada Health, brings deep experience in value-based care and chronic condition management, enhancing its strategic capabilities.

What critics are saying

  • The competitive landscape for telehealth-based OUD treatment is growing, requiring Ophelia to continuously innovate to maintain its edge.
  • Dependence on temporary DEA telemedicine flexibilities could pose a risk if regulations become more restrictive, impacting Ophelia's service delivery model.

What makes Ophelia unique

  • Ophelia's virtual-first model for opioid use disorder (OUD) treatment sets it apart by removing geographical and logistical barriers, unlike traditional in-person treatment centers.
  • Being designated as Pennsylvania's first virtual-first Center of Excellence (COE) underscores Ophelia's commitment to high standards in evidence-based treatment.
  • Ophelia's partnerships with major health insurers like Highmark Wholecare and MVP Healthcare ensure broader access to medication-assisted treatment (MAT), a critical differentiator in the OUD treatment landscape.

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