Provider Credentialing Specialist II

Qualifacts; Nashville (TN); Híbrido; USD 70.000 - 95.000; Jornada completa

Descripción de la vacante

Qualifacts is seeking a Provider Credentialing Specialist to join our Nashville or Tampa team on a hybrid schedule. You will stay current with regulatory developments, ensure accreditation compliance, manage credentialing for physicians and allied health professionals, and coordinate insurance paneling with payers and partners to support efficient credentialing workflows.

The role requires strong organizational skills, meticulous record keeping, and the ability to work cross-functionally with

Formación

• Proven experience in provider credentialing and insurance paneling.
• In-depth knowledge of industry’s standards and regulations.
• Provider Credentialing Specialist certification through NAMSS preferred.

Responsabilidades

• Keeps abreast of regulatory developments in Behavioral Health, Primary Care, and Medical Staff Services.
• Maintains compliance with regulatory and accrediting bodies.
• Works collaboratively with leadership to develop and implement credentialing processes and procedures.
• Credentialing of physicians, allied health, and other practitioners.
• Insurance paneling of facilities, physicians, allied health, and other practitioners.
• Collects and maintains an accurate practitioner database and verifies information.
• Collects and maintains records in licenses, credentials, and insurance contracts.
• Monitors providers’ credentials and licenses for Partners/Customers.
• Advises Partners/Customers on renewal procedures.
• Ensures timely completion of credentialing processes.
• Releases information to agencies and the public as required by law.
• Escalates credentialing risks to Billing Manager and Partner/Customer leadership.
• Develops and maintains credentialing processes and standards for the department.
• Keeps abreast of Joint Commission and CARF credentialing requirements.
• Keeps abreast of insurance paneling requirements for Medicare, Medicaid, and Commercial payers.
• Assists with development and operations of a customer call center.
• Provides credentialing consultations/trainings as requested.

Conocimientos

Credentialing

Insurance paneling

Regulatory knowledge

Communication

Educación

NAMSS Certification

Descripción del empleo

Job Description

Qualifacts is a leading provider of behavioral health software and SaaS solutions for clinical productivity, compliance and state reporting, billing, and business intelligence. Its mission is to be an innovative and trusted technology and end-to-end solutions partner, enabling exceptional outcomes for its customers and those they serve. Qualifacts’ comprehensive portfolio, including the CareLogic®, Credible™, and InSync® platforms, spans and serves the entire behavioral health, rehabilitative, and human services market supporting non-profit Certified Community Behavioral Health Clinics (CCBHC) as well as for-profit large enterprise and small business providers. Qualifacts has a loyal customer base, with more than 2,500 customers representing 75,000 providers serving more than 6 million patients. Qualifacts was recognized in the 2022 and 2023 Best in KLAS: Software and Services report as having the top ranked Behavioral Health EHR solutions.

We are seeking candidates in Nashville or Tampa to work a hybrid schedule in either office location. Remote candidates will not be considered.

Responsibilities for the Provider Credentialing Specialist

• Keeps abreast of regulatory developments in the Behavioral Health, Primary Care, and Medical Staff Services industries
• Maintains compliance with regulatory and accrediting bodies
• Works collaboratively with leadership in the development and implementation of credentialing processes and procedures
• Credentialing of physicians, allied health, and other practitioners
• Insurance paneling of facilities, physicians, allied health, and other practitioners
• Collects and maintains an accurate practitioner database and analyze verification information
• Collects and maintains records in licenses, credentials, and insurance contracts
• Monitors Partner/Customer’s providers’ credentials and licenses
• Works collaboratively with Partners/Customers to advise on renewal procedures
• Work collaboratively with Partners/Customers to ensure timely completion of credentialing processes
• Releases information to agencies and members of the public as required by law
• Escalates identified credentialing risks to Billing Manager and Partner/Customer leadership
• Has a subject matter expertise level provider credentialing and processes
• Develops and maintains credentialing processes and standards for the department
• Keeps abreast of credentialing requirements for Joint Commissions and CARF
• Keeps abreast of insurance paneling requirements for Medicare, Medicaid, and Commercial payers
• Assists with the development and operations of a customer call center
• Provides credentialing consultations/trainings as requested

Qualifications of Provider Credentialing Specialist

• Proven experience in provider credentialing and insurance paneling
• In-depth knowledge of industry’s standards and regulations
• Provider Credentialing Specialist certification through NAMSS preferred

Knowledge, Skills, and Abilities of the Provider Credentialing Specialist

• Ability to delve into the credentialing requirements of Partners
• Excellent communication and organizational skills
• Motivation and ability to manage concurrent projects, constituents, and priorities with tight deadlines in a dynamic environment
• Build positive and effective relationships with other leaders, internally and externally
• Regarded as a team player by colleagues and models company values and culture
• Ensures that all work adheres to company mission and goals
• Represents the company, mission, and values well to both internal and external stakeholders

Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.