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.

Life at Plutus Health

Plutus Health offers a unique work environment that is both thrilling and enriching, fostering personal and professional growth. Our company is a hub of innovation, collaboration, and continuous learning, where we encourage our employees to adopt a positive mindset and strive for excellence.

At Plutus Health, you'll be part of a vibrant team that thrives on creativity and problem-solving. You'll have the opportunity to work on cutting-edge projects, leveraging the latest technologies and methodologies to deliver intelligent solutions that make a tangible difference for our clients.

Plutus Health prioritizes the well-being of its employees and fosters a supportive and inclusive culture that promotes work-life balance. If you are enthusiastic about joining a vibrant organization that values your input, Plutus Health is the ideal place to pursue your career goals.

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 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.

Key Responsibilities

• Should 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 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.

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.