Payor Credentialing Specialist (Remote)

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 Payor Credentialing Specialist is responsible for the timely enrollment of providers, including but not limited to: physicians, advanced care practitioners such as nurse practitioners and physician assistants. This position is also responsible for the on-going maintenance of existing providers in organizational databases, as well as CAQH and plan-owned portals. Enrollment includes but is not limited to managed care organizations and government payors such as Medicare and Medicaid.

You will:

• Be responsible for data entry of provider enrollment information into Provider Enrollment Database systems and distribution of information to designated department representatives as needed
• Submit required enrollment information to payors in a timely and accurate manner to receive reimbursement for services rendered
• Follow-up with managed care organizations to ensure expedient credentialing. Pursue incomplete information with providers directly in order to develop a full and complete enrollment packet for submission to payors
• Be accountable for directly entering and updating provider data into the CAQH system, Verifiable system, and other credentialing information, ensuring attestations and supporting documentation are always current for all providers
• Be responsible for the on-going maintenance of existing providers’ data within all databases, both internal and external to the organization. Data could include but is not limited to the submission of any maintenance forms updating personal and practice demographic information; submission of updated supporting documentation as needed prior to expiry date; tracking of effective dates by products as needed; termination of providers from the organization
• Act as a liaison between internal departments such as Payor Operations, Clinical Operations, Contracting, Billing, Member Services, and other corporate departments as assigned
• Other duties as assigned.

You have:

• Knowledge of billing processes preferred
• National Association of Medical Staff Services (NAMSS) Certified Provider Credentialing Specialist (CPCS) certification a plus
• Knowledge of multi-state/national provider credentialing and/or enrollment required
• Knowledge of Google Workplace/Microsoft office or other task management suites
• Associates degree or equivalent combination of education and experience
• 3-5 years of working experience in a healthcare setting is required
• Experience with PECOS/Medicare and or state Medicaid enrollment platforms

What we offer / benefits:

• Life insurance, short and long term disability
• 401k
• A meaningful mission and humble, fun colleagues: a work environment that is respectful, collaborative, and driven
• Primary care and mental health care benefits via Sequoia
• Up to 4 weeks of PTO annually (no waiting period) and 10 company holidays
• Generous health care coverage (Blue plans + Kaiser in California)

Interested in learning more about Ophelia and this role? Apply below!

Salary range dependent on experience