Credentialing Customer Success Manager

Calpion/Plutus Health • Dallas, TX

8d

About The Position

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.

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.

Nice To Haves

• 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.

Responsibilities

• 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed