calpionplutus
Credentialing Customer Success Manager
Dallas, Texas
Sponsorship not specifiedDetected 5 days ago
ComplianceSalesExcelProcess ImprovementCustomer SuccessHIPAAPatient CareCommunication
About the role
- 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.
- 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.
Responsibilities
- Collaborate with the sales team to support and enhance sales initiatives
- Maintain credentialing trackers and ensure data accuracy.
- Support audits and ensure compliance with HIPAA and payer-specific guidelines.
- This role is critical to maintain operational efficiency and timely provider onboarding across multiple clients and specialties.
- Initiate phone calls and build rapport with the payer enrollment department to accelerate the
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).
- Proficiency in Microsoft Excel, credentialing databases, and tools.
- Experience handling credentialing for various specialties and multi-state providers.
- Familiarity with payer-specific credentialing nuances and timelines.
- Collaborate with the offshore team to identify missing documentation and coordinate with the client to obtain the required information
- Coordinate with internal teams and clients to gather required documentation and resolve discrepancies.
Nice to have
- Preferred Attributes
Benefits
- 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.
- 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.
- Verify provider credentials including licenses, certifications, education, and work history.
Visa & Work Authorization
- CAQH, PECOS, NPPES, OIG, SAM, MEDICAID EXCLUSION, MEDICARE OPT OUT LIST, SOCIAL SECURITY DEATH MASTER FILE.
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