Hybrid Credentialing Specialist II — Regulatory & Paneling

Qualifacts Systems, LLC.; Tampa (FL); Hybrid; USD 52,000 - 74,000; Full time

Job summary

Qualifacts is seeking a Provider Credentialing Specialist to manage credentialing processes for physicians and allied health professionals in a hybrid Tampa or Nashville setting.

You will maintain practitioner databases, verify licenses and credentials, and coordinate with Partners/Customers to ensure timely renewals and accurate paneling for Medicare, Medicaid, and commercial payers.

Qualifications

• Proven experience in provider credentialing and insurance paneling.
• In-depth knowledge of industry standards and regulations.
• NAMSS certification preferred.

Responsibilities

• Credential physicians, allied health, and other practitioners.
• Panel facilities, physicians, and other practitioners for insurance networks.
• Maintain practitioner databases and verify licenses, credentials, and contracts.
• Monitor credentials and licenses of Partner/Customer providers.
• Guide renewal procedures and advise on substantiating documentation.
• Release information to agencies and required parties as needed.

Skills

Credentialing

Communication

Organizational skills

Deadline management

Education

NAMSS certification preferred

Job description

Qualifacts is seeking a Provider Credentialing Specialist to manage credentialing processes for physicians and allied health professionals in a hybrid Tampa or Nashville setting.

You will maintain practitioner databases, verify licenses and credentials, and coordinate with Partners/Customers to ensure timely renewals and accurate paneling for Medicare, Medicaid, and commercial payers.