What are the responsibilities and job description for the Credentialing Customer Success Manager position at Calpion/Plutus Health?
About Plutus Health Inc.:
Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services, certified in SOC2 compliance and recognized among the Inc. 5000 fastest-growing private companies. We specialize in revenue cycle optimization for hospitals, physician groups, and healthcare organizations across various specialties. Our commitment to innovation and excellence has earned us recognition as a 2024 EY Entrepreneur Of The Year finalist and one of the top 100 fastest-growing companies in Dallas.
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.
Why Join Plutus Health Inc.?
- Work for a fast-growing, innovative company recognized for excellence in healthcare.
- Collaborate with a dynamic, supportive team that values professional development.
- Make a meaningful impact on patient care and operational success.