Credentialing Customer Success Manager

About Calpion

Calpion is a technology company based in Dallas with 18 years of experience, specializing in artificial intelligence solutions including custom deep learning, machine learning algorithms, enterprise application development, RPA services, cloud and Salesforce consulting, and medical billing automation. Their healthcare technology encompasses Salesforce-based practice management and billing software featuring automated patient e-statements and payment portals. Calpion is SOC-certified, HIPAA-compliant, and partners with leading tech firms such as Microsoft, Amazon, SAP, and UiPath, serving industries like healthcare, logistics, biotechnology, hospitality, manufacturing, and airlines.

Life at Calpion

Calpion fosters an innovative and collaborative environment that supports personal and professional growth. The company values creativity, problem-solving, and continuous learning while promoting employee well-being and work-life balance in an inclusive culture.

Role Overview

The Credentialing Customer Success Manager role involves supporting the U.S. healthcare credentialing processes by overseeing end-to-end provider credentialing to ensure adherence to payer and regulatory requirements. The position requires collaboration with an offshore team and coordination across multiple clients and specialties to maintain operational efficiency and timely provider onboarding.

Key Responsibilities

• Manage initial credentialing, re-credentialing, and enrollment for providers across Medicare, Medicaid, and commercial payers.
• Act as the liaison between clients and the offshore credentialing team, ensuring adherence to service level agreements.
• Ensure provider profiles are accurate and up to date through coordination with the offshore team.
• Identify missing documentation and work with clients to obtain necessary paperwork.
• Communicate directly with payer enrollment departments to speed application processing.
• Verify provider credentials such as licenses, certifications, education, and employment history.
• Support sales teams to enhance initiatives through credentialing insights.
• Coordinate with internal and client teams to collect documentation and resolve credentialing issues.
• Maintain credentialing tracking systems and guarantee data accuracy.
• Assist with audits and ensure compliance with HIPAA and payer guidelines.
• Contribute to credentialing meetings and recommend process improvements.

Required Experience and Skills

• Over 10 years of U.S. provider credentialing experience.
• Knowledge of CAQH, PECOS, NPPES, and payer portals such as Anthem, Optum, and Medicaid MCOs.
• Excellent organizational and communication skills.
• Proficient with Microsoft Excel and credentialing management tools.

Preferred Qualifications

• Experience managing credentialing for multi-state providers across various specialties.
• Ability to work independently and multitask effectively.
• Strong attention to detail and commitment to data accuracy.
• Understanding of payer-specific credentialing requirements and timelines.

Tools and Systems Utilized

• Credentialing and regulatory platforms including CAQH, PECOS, NPPES, OIG, SAM, Medicaid Exclusion lists, Medicare Opt-Out, and Social Security Death Master File.
• Payer portals from UnitedHealthcare, Blue Cross Blue Shield, Cigna, Humana, and various state Medicaid programs.
• Credentialing dashboards and Excel trackers.

Company Culture and Core Values

• Agile: Embracing change and adapting quickly to challenges.
• Collaborative: Achieving success through teamwork and diverse perspectives.
• Innovative: Continuously exploring new ideas and boundaries.
• Fun: Fostering a joyful and supportive workplace.
• Inclusive: Valuing diversity and ensuring everyone’s voice is heard.
• Passionate: Committed to excellence and enthusiasm in every task.