Role Summary
Plutus Health is seeking a detail-oriented and proactive Client Success Manager - Provider Credentialing to join our U.S. Client Success Manager credentialing team. You will be responsible for working with the offshore team in providing the end-to-end credentialing process for healthcare providers, ensuring compliance with payer requirements and regulatory standards. This role is critical to maintain operational efficiency and timely provider onboarding across multiple clients and specialties.
Key Responsibilities
- Should have a good understanding of initial credentialing, re-credentialing, and enrollment processes for providers across Medicare, Medicaid, and commercial payers.
- Serve as the communication bridge between the client and the offshore team to ensure service level agreements (SLAs) are consistently met
- Work with the offshore team in making sure provider profiles are kept up to date.
- Collaborate with the offshore team to identify missing documentation and coordinate with the client to obtain the required information
- Initiate phone calls and build rapport with the payer enrollment department to accelerate the application process
- Verify provider credentials including licenses, certifications, education, and work history.
- Collaborate with the sales team to support and enhance sales initiatives
- Coordinate with internal teams and clients to gather required documentation and resolve discrepancies.
- Maintain credentialing trackers and ensure data accuracy.
- Support audits and ensure compliance with HIPAA and payer-specific guidelines.
- Participate in credentialing meetings and contribute to process improvement initiatives.
Requirements
- 7+ years of experience in U.S. provider credentialing.
- Familiarity with CAQH, PECOS, NPPES, and payer-specific portals (e.g., Anthem, Optum, Medicaid MCOs).
- Strong organizational and communication skills.
- Proficiency in Microsoft Excel, credentialing databases, and tools.
Preferred Attributes
- Experience handling credentialing for various specialties and multi-state providers.
- Ability to work independently and manage multiple priorities.
- Strong attention to detail and commitment to data accuracy.
- Familiarity with payer-specific credentialing nuances and timelines.
Tools & Systems
- CAQH, PECOS, NPPES, OIG, SAM, MEDICAID EXCLUSION, MEDICARE OPT OUT LIST, SOCIAL SECURITY DEATH MASTER FILE.
- Payer portals including UHC, BCBS, Cigna, Humana, State Medicaid.
- Credentialing dashboards and Excel-based trackers.
