Credentialing Customer Success Manager

Calpion/Plutus Health

$70K — $95K *
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • 10+ years of experience in U.S. provider credentialing
  • Strong familiarity with CAQH, PECOS, and NPPES
  • Proficiency in Microsoft Excel and credentialing databases
  • Experience with multi-state provider credentialing
  • Excellent organizational and communication skills

Responsibilities

  • Understand initial credentialing, re-credentialing, and enrollment processes
  • Act as a liaison between clients and the offshore team
  • Ensure provider profiles are current and compliant
  • Identify missing documentation for provider applications
  • Initiate communication with payer enrollment departments
  • Verify provider credentials and compliance documentation
  • Support sales initiatives through collaborative efforts

Benefits

  • Potential for professional development and process improvement
  • Access to an experienced offshore support team
  • Opportunity to work across diverse healthcare specialties
  • Engagement in process-driven credentialing meetings
  • Strong emphasis on compliance with healthcare regulations
Full Job Description
Role Summary Plutus Health is seeking a detail-oriented and proactive Credentialing Specialist to join our U.S. credentialing team. You will be responsible to work with 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 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 10+ 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.

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