Provider Credentialing Specialist II: Compliance Leader

Qualifacts Systems Inc.; Nashville (TN); Hybrid; USD 52,000 - 78,000; Full time

Job summary

Qualifacts is seeking a Provider Credentialing Specialist to ensure compliant credentialing across behavioral health and related fields. You will support physicians, allied health professionals, and other practitioners through evidence-based credentialing processes in a fast-paced environment.

The role emphasizes collaboration with Partners/Customers and leadership to maintain accurate credentialing records and timely renewals, with a hybrid schedule in Nashville or Tampa.

Qualifications

• Proven experience in provider credentialing and insurance paneling.
• In-depth knowledge of industry standards and regulations.
• NAMSS certification preferred.
• Strong communication and organizational skills.
• Ability to manage concurrent projects and meet tight deadlines.

Responsibilities

• Keeps abreast of regulatory developments in Behavioral Health, Primary Care, and Medical Staff Services.
• Maintains compliance with regulatory and accrediting bodies.
• Works 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 others.
• Maintains practitioner database and verifies information.

Skills

Credentialing expertise

Regulatory knowledge

Communication skills

Organizational skills

Project management

Education

NAMSS certification preferred

Job description

Qualifacts is seeking a Provider Credentialing Specialist to ensure compliant credentialing across behavioral health and related fields. You will support physicians, allied health professionals, and other practitioners through evidence-based credentialing processes in a fast-paced environment.

The role emphasizes collaboration with Partners/Customers and leadership to maintain accurate credentialing records and timely renewals, with a hybrid schedule in Nashville or Tampa.