Provider Credentialing Specialist

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. Location: Nashville or Tampa – hybrid schedule in either office. Remote candidates will not be considered. Responsibilities Keep abreast of regulatory developments in the Behavioral Health, Primary Care, and Medical Staff Services industries Maintain compliance with regulatory and accrediting bodies Work collaboratively with leadership in the development and implementation of credentialing processes and procedures Credential physicians, allied health, and other practitioners Conduct insurance paneling of facilities, physicians, allied health, and other practitioners Collect and maintain an accurate practitioner database and analyze verification information Collect and maintain records in licenses, credentials, and insurance contracts Monitor Partner/Customer’s providers’ credentials and licenses Work collaboratively with Partners/Customers to advise on renewal procedures Ensure timely completion of credentialing processes Release information to agencies and members of the public as required by law Escalate identified credentialing risks to the Billing Manager and Partner/Customer leadership Demonstrate subject matter expertise in provider credentialing and processes Develop and maintain credentialing processes and standards for the department Stay informed of credentialing requirements for Joint Commission and CARF Keep abreast of insurance paneling requirements for Medicare, Medicaid, and commercial payers Assist with the development and operations of a customer call center Provide credentialing consultations and training as requested Qualifications Proven experience in provider credentialing and insurance paneling In‑depth knowledge of industry standards and regulations Provider Credentialing Specialist certification through NAMSS (preferred) 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 demonstrates company values and culture Ensure that all work adheres to company mission and goals Represent 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. #J-18808-Ljbffr