Qualifacts is a leading provider of behavioral health software and SaaS solutions for clinical productivity, compliance and state reporting, billing, and business intelligence. The company serves the behavioral health, rehabilitative, and human services market with a portfolio of EHR platforms designed to improve outcomes for providers and the people they serve.
This role supports provider credentialing and insurance paneling across behavioral health, primary care, and medical staff services. The position works in a hybrid environment in Tampa or Nashville, and remote candidates will not be considered.
Responsibilities include:
- Maintain awareness of regulatory developments in behavioral health, primary care, and medical staff services
- Ensure compliance with regulatory and accrediting bodies
- Collaborate with leadership to develop and implement credentialing processes and procedures
- Credential physicians, allied health professionals, and other practitioners
- Manage insurance paneling for facilities and practitioners
- Collect, maintain, and analyze practitioner database and verification information
- Maintain records for licenses, credentials, and insurance contracts
- Monitor provider credentials and licenses for partners and customers
- Support renewal procedures and timely completion of credentialing processes
- Release information to agencies and the public as required by law
- Escalate credentialing risks to billing leadership and partner/customer leadership
- Develop and maintain credentialing standards for the department
- Track credentialing requirements for Joint Commission and CARF
- Track insurance paneling requirements for Medicare, Medicaid, and commercial payers
- Assist with customer call center operations
- Provide credentialing consultations and training as requested
Requirements & Qualifications
Qualifications
- Proven experience in provider credentialing and insurance paneling
- In-depth knowledge of industry standards and regulations
- Provider Credentialing Specialist certification through NAMSS preferred
Skills and abilities
- Ability to understand and interpret partner credentialing requirements
- Strong communication and organizational skills
- Ability to manage multiple projects, constituents, and priorities under tight deadlines
- Ability to build positive and effective relationships with internal and external leaders
- Team-oriented mindset with alignment to company values and culture
- Ability to represent the company mission and values professionally
Location
Tampa, Florida, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago
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