Credentialing - Client Success Manager

HealthPay Inc; Dallas (TX); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Professional development opportunities

Collaborative work environment

Impact on patient care

Job summary

HealthPay Inc. is searching for a Credentialing - Client Success Manager to manage the credentialing process for healthcare providers. This role involves ensuring compliance with payer requirements and working closely with a remote team to gather documentation and verify credentials. Candidates must have 7+ years of experience in U.S. provider credentialing and strong communication skills. We're renowned for our innovative approach and commitment to excellence in the healthcare industry.

Qualifications

• 7+ years of experience in U.S. provider credentialing.
• Familiarity with CAQH, PECOS, NPPES, and payer-specific portals.
• Strong organizational and communication skills.

Responsibilities

• Work with offshore team to provide end-to-end credentialing process.
• Serve as communication bridge between client and offshore team.
• Verify provider credentials including licenses, certifications, and education.

Skills

Organizational skills

Communication skills

Attention to detail

Proficiency in Microsoft Excel

Tools

CAQH

PECOS

NPPES

Job description

Credentialing - Client Success Manager

About
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.

Job Title: Credentialing - Client Success Manager

Experience: 7+ years of experience in U.S. provider credentialing

Location: Dallas, Texas / Remote

Employment Type: Full-time

Job Summary

Plutus Health is seeking a detail-oriented and proactive Credentialing Client Success Manager to join our U.S. credentialing team. You will be responsible for working 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 is critical to maintaining operational efficiency and timely provider onboarding across multiple clients and specialties.

Key Responsibilities

• 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 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 payer enrollment departments 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.

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.