Credentialing Specialist

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.

Responsibilities

• Coordinate and manage the credentialing and re-credentialing process for healthcare providers, including physicians, nurses, therapists, and other allied health professionals.
• Collect and review provider credentialing applications, ensuring accuracy and completeness of information.
• Verify provider credentials, including education, training, licensure, certifications, and professional experience, through primary sources and credentialing databases.
• Communicate with healthcare providers, licensing boards, professional organizations, and insurance carriers to obtain necessary documentation and resolve credentialing issues.
• Maintain accurate and up-to-date provider credentialing files and databases, ensuring compliance with regulatory standards and accreditation requirements.
• Monitor and track credentialing status and expirations, initiating re-credentialing processes as needed to maintain provider network participation.
• Collaborate with internal departments, including billing, compliance, and human resources, to ensure timely credentialing and enrollment of providers.
• Stay informed about changes in credentialing standards, regulations, and industry best practices, and incorporate updates into credentialing processes and procedures.
• Assist with special projects and initiatives related to provider credentialing and network management as assigned.
  
  

Qualifications

• Bachelors degree in healthcare administration, business administration, or related field preferred.
• Minimum of 2 years of experience in credentialing and provider enrollment, preferably in a healthcare or RCMS setting.
• Proficiency in credentialing software and databases, such as CAQH, NPPES, and payer-specific enrollment portals is a plus.
• Excellent organizational skills and attention to detail, with the ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Effective communication and interpersonal skills, with the ability to collaborate with internal and external stakeholders.
• Knowledge of medical terminology, healthcare billing, and reimbursement processes is a plus.
  
  

If you are a motivated professional with experience in credentialing and provider enrollment, we invite you to apply for the Credentialing Specialist position and join our dynamic team in the RCMS industry.

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

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