Provider Credentialing Specialist II

Qualifacts Systems Inc.; Tampa (FL); Hybrid; USD 52.000 - 72.000; Vollzeit

Benefits dieser Stelle

Hybrid work schedule

Inclusive environment

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Provider credentialing

Insurance paneling

Communication skills

Organizational skills

Project management

Stakeholder collaboration

NAMSS certification preferred

Jobbeschreibung

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.If you want to work inside an atmosphere where innovation has purpose, and your ambition works to support our customers and those they serve, please apply today!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 SpecialistKeeps abreast of regulatory developments in the Behavioral Health, Primary Care, and Medical Staff Services industriesMaintains compliance with regulatory and accrediting bodiesWorks collaboratively with leadership in the development and implementation of credentialing processes and proceduresCredentialing of physicians, allied health, and other practitionersInsurance paneling of facilities, physicians, allied health, and other practitionersCollects and maintains an accurate practitioner database and analyze verification informationCollects and maintains records in licenses, credentials, and insurance contractsMonitors Partner/Customer’s providers’ credentials and licensesWorks collaboratively with Partners/Customers to advise on renewal proceduresWork collaboratively with Partners/Customers to ensure timely completion of credentialing processesReleases information to agencies and members of the public as required by lawEscalates identified credentialing risks to Billing Manager and Partner/Customer leadershipHas a subject matter expertise level provider credentialing and processesDevelops and maintains credentialing processes and standards for the departmentKeeps abreast of credentialing requirements for Joint Commissions and CARFKeeps abreast of insurance paneling requirements for Medicare, Medicaid, and Commercial payersAssists with the development and operations of a customer call centerProvides credentialing consultations/trainings as requestedQualifications of Provider Credentialing SpecialistProven experience in provider credentialing and insurance panelingIn-depth knowledge of industry’s standards and regulationsProvider Credentialing Specialist certification through NAMSS preferredKnowledge, Skills, and Abilities of the Provider Credentialing SpecialistAbility to delve into the credentialing requirements of PartnersExcellent communication and organizational skillsMotivation and ability to manage concurrent projects, constituents, and priorities with tight deadlines in a dynamic environmentBuild positive and effective relationships with other leaders, internally and externallyRegarded as a team player by colleagues and models company values and cultureEnsures that all work adheres to company mission and goalsRepresents the company, mission, and values well to both internal and external stakeholdersQualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.