Credentialing Specialist II

Benefits

Additional Information

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. This is an onsite position, 5 days/week, in the Vadodara office. NIGHT SHIFT. Hours are 6:30pm-3:30am IST. Remote applicants will not be considered. Job Duties Maintain organized and accurate files to ensure the credentialing is obtained from all physician and non-physician providers. Timely and appropriately apply for, process, submit, and maintain credentials and licensing with insurance companies and federally subsidized government plans, such as Medicare and Medicaid Ensure that all insurance companies have current and accurate information they need to process claims in a timely manner. Verify compliance of all documents prior to submission. Communicate effectively with clients on payer registration status and updates. Build and maintain relationships with payer representatives. Proactively identify and resolve any issues a client may face during the payer registration process. Demonstrate self-management behaviors and being a self-starter, following established policies and procedures and promote an efficient, cost effective work environment. Keep RCM Account Managers, Supervisors and management, and providers informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, plans, etc. to prevent delayed claims filing and cash flows. Sets up and maintains provider information in online credentialing databases and system Track license and certification expirations for all providers to ensure timely renewals Job Requirements 2-3 years of insurance credentialing experience including federal government plans Certified Provider Credentialing Specialist (CPCS) preferred Hands-on knowledge of the credentialing process Strong written and oral communications skills Working knowledge of Medical Terminology. May require some travel Experience working directly with providers Microsoft Office Suite Ability to work in a fast-paced environment Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.