Credentialing Coordinator

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. 

Key Responsibilities 

• Create customer folders on Microsoft Teams/SharePoint and send welcome communications within defined timelines. 

• Schedule and coordinate welcome/kickoff calls; prepare agendas, notes, and follow-ups. 

• Enter and validate customer group and provider information in the Credentialing Management Database (CMD), ensuring accuracy and completeness. 

• Prepare and submit Managed Care Organization (MCO) rosters per payer requirements; track submissions and confirmations. 

• Support application submissions (e.g., Medicaid, Medicare, commercial) by assembling documentation, updating trackers, and routing to Specialists for review. 

• Conduct regular status checks with payers and document outcomes; escalate delays per SOPs. 

• Maintain weekly credentialing usage and invoice reports; reconcile data with internal systems and share with stakeholders. 

• Update credentialing status spreadsheets and dashboards; ensure new providers and changes are reflected promptly. 

• Adhere to standard operating procedures (SOPs), data quality standards, and security/compliance requirements (e.g., handling PHI). 

• Collaborate across India/U.S. teams; contribute to process improvements and knowledge assets (templates, guides, FAQs). 

Success Metrics 

The following metrics reflect baseline expectations aligned to our credentialing workflow. Specific targets will be calibrated with the Credentialing Manager and customer SLAs. 

• Onboarding setup: customer folders created and welcome email sent within 3 business days of assignment; >95% on-time. 

• Data accuracy: ≥98% field-level accuracy for CMD customer group and provider entries (spot-check audits). 

• Throughput: ability to process baseline volumes consistent with time standards (e.g., customer group entries and provider entries per the standard time guidelines). 

• Payer follow-up: status checks performed at least every 7 business days, with outcomes logged in CMD/trackers. 

• Reporting timeliness: weekly usage and invoice reports delivered on schedule with zero critical discrepancies. 

• Service quality: internal/customer satisfaction scores at or above target; minimal rework due to data errors. 

• Collaboration & communication: timely, complete updates in meeting notes, trackers, and Teams channels. 

Qualifications 

Education & Experience: 

• Bachelor’s degree preferred; equivalent experience considered. 

• Minimum of one year of experience in healthcare or related operations is preferred. 

Technical Skills: 

• Proficiency with Microsoft 365 (Teams, SharePoint, Excel). 

• Experience with credentialing systems and databases (e.g., CMD) and familiarity with CAQH profiles/attestations. 

• Comfort working with templates, trackers, and large data sets with strong attention to detail. 

Core Competencies: 

• Detail orientation and data accuracy; able to follow SOPs and maintain documentation standards. 

• Strong written and verbal communication; able to coordinate across time zones. 

• Organization and time management; able to balance multiple accounts and deadlines. 

• Problem solving and escalation judgment; continuous improvement mindset. 

Work Conditions 

This is a full-time role based in Vadodara, India, with collaboration across India and U.S. time zones Working hours are 5:30 PM – 2:30 AM IST.  

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