Credentialing Customer Success Manager

Plutus Health Inc. is seeking a detail-oriented and proactive Credentialing Specialist to join our U.S. credentialing team. You will work with an offshore team to provide the end-to-end credentialing process for healthcare providers, ensuring compliance with payer requirements and regulatory standards. This role supports operational efficiency and timely provider onboarding across multiple clients and specialties.

Responsibilities

• Understand 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 to keep provider profiles 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.

For more information about this role and to apply, please contact the Plutus Health Inc. recruiting team.

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