Credentialing Customer Success Manager

Plutus Health Inc.; Dallas (TX); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Professional development opportunities

Dynamic team environment

Job summary

A growing healthcare organization in Dallas, Texas is seeking a Credentialing Specialist with extensive U.S. provider credentialing experience. The role involves working with offshore teams for provider onboarding and ensuring compliance with payer requirements. Ideal candidates will possess strong organizational and communication skills, and familiarity with credentialing databases. Join a dynamic team dedicated to excellence in healthcare.

Qualifications

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

Responsibilities

• Understand credentialing, re-credentialing, and enrollment processes.
• Serve as the bridge between the client and the offshore team.
• Verify provider credentials including licenses and certifications.

Skills

Organizational skills

Communication skills

Attention to detail

Tools

Microsoft Excel

Credentialing databases

Job description

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.