Provider Credentialing Specialist: Compliance & Paneling

Qualifacts Systems Inc.; Tampa (FL); Hybrid; USD 52,000 - 72,000; Full time

Benefits offered by this job

Hybrid work schedule

Inclusive environment

Job summary

Qualifacts Systems Inc. seeks a Provider Credentialing Specialist to ensure compliant credentialing for physicians and allied health professionals across behavioral health and related fields.

You will maintain accurate practitioner databases, verify licenses, and manage credentialing records. This role supports collaboration with Partners/Customers, guides renewal procedures, and keeps abreast of Joint Commission and CARF requirements.

Qualifications

• Proven experience in provider credentialing and insurance paneling.
• In-depth knowledge of industry standards and regulations.
• NAMSS certification preferred.
• Excellent communication and organizational skills.
• Ability to manage concurrent projects and priorities under tight deadlines.
• Build positive relationships with internal and external leaders.
• Knowledge of Joint Commission and CARF credentialing requirements.

Responsibilities

• Keeps abreast of regulatory developments in Behavioral Health, Primary Care, and Medical Staff Services industries.
• Maintains compliance with regulatory and accrediting bodies.
• Develops and maintains credentialing processes and standards for the department.
• Credentialing of physicians, allied health, and other practitioners.
• Insurance paneling of facilities, physicians, allied health, and other practitioners.
• Collects and maintains accurate practitioner databases and verifies information.
• Monitors providers’ credentials and licenses.
• Advises Partners/Customers on renewal procedures.
• Ensures timely completion of credentialing processes.
• Releases information to agencies and members of the public as required by law.
• Escalates credentialing risks to leadership.
• Provides credentialing consultations/trainings as requested.

Skills

Provider credentialing

Insurance paneling

Communication skills

Organizational skills

Project management

Stakeholder collaboration

NAMSS certification preferred

Job description

Qualifacts Systems Inc. seeks a Provider Credentialing Specialist to ensure compliant credentialing for physicians and allied health professionals across behavioral health and related fields.

You will maintain accurate practitioner databases, verify licenses, and manage credentialing records. This role supports collaboration with Partners/Customers, guides renewal procedures, and keeps abreast of Joint Commission and CARF requirements.