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Ophelia · 2 months ago

Team Lead, Licensing and Credentialing

United States

Full-time

Remote

Mid, Senior Level

$85K/yr - $95K/yr

5+ years exp

Ophelia is a venture-backed healthcare startup focused on providing accessible treatments for opioid use disorder through a telehealth platform. The Licensing & Credentialing Lead will manage the licensing and credentialing processes while mentoring a team of specialists to ensure compliance and operational excellence.

Health CareHome Health CarePharmaceuticalTherapeutics

Responsibilities

Execute licensing, credentialing, and enrollment processes across assigned markets with accuracy, timeliness, and compliance

Serve as the primary escalation point for complex or at-risk applications, troubleshooting issues and supporting providers and Specialists

Mentor, train, and guide L&C Specialists, providing daily oversight, quality checks, and workload support

Maintain accurate documentation, updates, and audit-ready records across all credentialing and workflow systems

Identify workflow gaps and recommend improvements to enhance efficiency, accuracy, and scalability of L&C operations

Serve as the L&C SME with external partners, including payors, Medicaid agencies, and licensing boards, to reduce delays and resolve escalations

Collaborate cross-functionally (Billing and Clinical Ops) to resolve issues, clarify requirements, and drive alignment

Support SOP updates, audits, and implementation of new processes as NCQA, CMS, state, and payor requirements evolve

Qualification

LicensingCredentialingProvider enrollmentCPCS certificationNCQA knowledgeCMS/Medicare knowledgeMulti-state regulationsCredentialing systems proficiencyProfessionalismMentoring skillsCommunication skills

Required

5+ years previous experience in licensing, credentialing, or provider enrollment within a healthcare or behavioral health setting across multiple states

Experience leading or mentoring others within the licensing and credentialing environment

National Association of Medical Staff Services (NAMSS) Certified Provider Credentialing Specialist (CPCS) certification

Strong knowledge of NCQA, CMS/Medicare, CAQH, Medicaid, and multi-state licensing/credentialing regulations

Proficiency with credentialing systems, workflow tools, and productivity platforms (ClickUp, Slack, MS/Google Suite)

Ability to build strong relationships and communicate clearly across internal and external teams

High degree of professionalism, confidentiality, and accountability

Benefits

Remote work anywhere in the United States

Competitive medical, vision, and health insurance (many plans are fully covered for the employee!)

20 days of PTO per year

10 company holidays

401k Contribution Platform

Additional benefits offered through our benefits provider such as life insurance, short and long term disability, financial wellness, virtual primary care, among others!