Qualifacts is a leading provider of behavioral health software and Saa S 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 Care Logic®, Credible™, and In Sync® 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.
This is an onsite position, 5 days/week, in Vadodara office-Gujarat
Shift: - NIGHT/US SHIFT. Hours are 6:30pm-3:30am IST.
Remote applicants will not be considered.
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:
- Bachelor's degree in healthcare administration, business administration, or related field preferred.
- 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.
