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.
Credentialing Manager
to oversee the day-to-day operations of the credentialing team supporting our Revenue Cycle Management Services (RCMS) customers. This role will be responsible for managing credentialing processes, ensuring compliance with payer and regulatory requirements, optimizing tools and systems to ensure efficiency and a positive customer experience, and driving operational excellence. The Credentialing Manager will collaborate closely with U.S. stakeholders, the India Director of Operations, and cross-functional teams to ensure credentialing operations meet customer expectations and contribute to growth and retention
Job Overview
- Manage day-to-day operations of the credentialing team in India, ensuring timely and accurate completion of credentialing and re-credentialing activities.
- Supervise staff, provide coaching, and ensure adherence to standard operating procedures and best practices.
- Optimize tools, technology, and credentialing systems to drive efficiency, accuracy, and a positive customer experience.
- Partner with the U.S. credentialing and operations leadership to align on processes, KPIs, and customer strategies.
- Ensure compliance with payer requirements, NCQA standards, and other regulatory guidelines.
- Oversee provider enrollment activities, including new applications, revalidations, and updates.
- Monitor credentialing performance metrics (e.g., turnaround time, accuracy, payer approval rates) and report progress to leadership.
- Identify opportunities for process automation and efficiency improvements.
- Act as point of escalation for complex credentialing issues or customer concerns.
- Collaborate with Revenue Cycle, Customer Success, and Implementation teams to ensure credentialing supports overall service delivery.
- Assist in developing training programs and documentation to standardize credentialing practices across the team.
Key Tasks and Scope of Work
- Timely completion of credentialing and re-credentialing activities.
- High accuracy and compliance with payer/regulatory requirements.
- Optimized tools and systems supporting efficiency and customer satisfaction.
- Reduced credentialing-related delays impacting customer revenue.
- Positive customer feedback and increased retention linked to credentialing support.
- Efficient and scalable credentialing processes supported by automation and standardization.
Qualifications
- Bachelor’s degree in business administration, Healthcare Management, or related field.
- 4+ years of experience in provider credentialing or enrollment, with at least 2 years in a leadership/supervisory role.
- Strong understanding of payer credentialing requirements, NCQA standards, and healthcare compliance.
- Familiarity with behavioral health provider credentialing preferred.
- Experience with credentialing software and EHR platforms (CareLogic, Credible, or InSync a plus).
- Strong leadership and people management skills with ability to mentor and develop staff.
- Excellent communication, problem-solving, and organizational skills and ability to collaborate across geographies and time zones.
This is an onsite position, 5 days/week, in the Vadodara office working the NIGHT SHIFT. Hours are 6:30pm-3:30am IST. Remote applicants will not be considered.
Qualifacts is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
