Credentialing Customer Success Manager

• 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.
  

• 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.
  

• 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.
  

• 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.
  

Our Culture & Values

At Calpion, were not just a company were a dynamic culture fueled by six core values: Agile, Collaborative, Innovative, Fun, Inclusive, and Passionate. These values drive our every move:

• Agile:

  We thrive on change, adapting swiftly to new challenges.

• Collaborative:

  Together, we achieve greatness through teamwork and diverse perspectives.

• Innovative:

  We push boundaries, constantly exploring new ideas and solutions.

• Fun:

  Laughter and camaraderie make our workplace a joyous one.

• Inclusive:

  Diversity is our strength, ensuring every voice is heard and valued.

• Passionate:

  We approach every task with dedication and enthusiasm.

Join us at Calpion and be part of a culture thats not just about work but innovation, growth, and making an impact.