Credentialing Customer Success Manager

About
Calpion is an 18-year-old Dallas-headquartered technology firm that offers customers artificial intelligence solutions by building custom deep learning and machine learning algorithms, custom enterprise application development and maintenance, RPA solutions, cloud services, Salesforce consulting, customized invoice management software solutions, and other technology services. We also offer automated bot-driven medical billing services. Our healthcare offering includes a Salesforce platform-based practice management and billing software with automated patient e-statements and a payment portal.

Along With Being SOC-certified And HIPPA-compliant, We Have

• Certified experts in deep learning & machine learning to provide intelligent solutions for your business.
• Helped Fortune 500 companies build custom enterprise-level applications.
• Provide remote & accurate AutoCAD Drawing, Drafting, 2D &3D modeling, and design services.
• Strategic partnerships with Microsoft, Amazon, SAP, HP, Worksoft, Microfocus, Tricentis, etc.
• Partnered with UiPath to provide RPA solutions.
• We are headquartered in Dallas with multiple global Centers of Excellence around the industry. ‍

Focus:
Healthcare, Logistics, Supply chain, Biotechnology, Hospitality, Manufacturing, and Airlines.

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Life at Calpion Inc.

Calpion 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 Calpion, you'll be part of a vibrant team that thrives on creativity and problem-solving. You'll have the chance to work on cutting-edge projects, harnessing the latest technologies and methodologies to deliver intelligent solutions that make a real difference for our clients.

Calpion 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, Calpion is the ideal place to pursue your career goals.

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Job Title:
Credentialing Customer Success Manager

Company:
Calpion Software India Pvt. Ltd

Location:
Bengaluru, India

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Job Summary
Seeking a detail-oriented and proactive Credentialing Specialist to join our U.S. credentialing team. You will be responsible for working 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.

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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. ‍

Required Skills & Experience

• 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 Qualifications

• 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. ‍

Our Culture & Values
At Calpion, we're not just a company—we're 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 that's not just about work but innovation, growth, and making an impact.