Credentialing Specialist

Astrana Health, Inc.•Beaumont, TX

1d•$19 - $25•Remote

About The Position

The Credentialing Specialist supports Astrana Health’s Clinic Operations team by ensuring healthcare providers are appropriately credentialed and enrolled with health plans, government programs, and regulatory agencies. The role acts as a liaison among providers, health plans, and internal stakeholders to complete credentialing and enrollment accurately and on time. It supports compliance, provider network integrity, and accurate provider data across multiple systems and payer platforms. The role follows a remote work structure with periodic travel to clinics. It requires extended computer work and communication with providers and staff through phone, video conferencing, email, and Teams chat. Attendance at provider meetings, trainings, and market events may be needed. The target pay range is $19–$25 per hour; actual compensation depends on geographic location, experience, qualifications, internal equity, and other job-related factors.

Requirements

High school diploma or equivalent.
At least 2 years of provider credentialing experience within a physician practice, medical group, IPA, MSO, health plan, or managed care environment.
Experience with CAQH, PECOS, NPPES, Medicare enrollment and revalidation, Medicaid enrollment, and commercial payer credentialing processes.
Strong knowledge of credentialing standards, enrollment procedures, and healthcare regulatory requirements.
Experience working with electronic health records, practice management systems, and credentialing platforms.
Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook.
Strong analytical, organizational, communication, problem-solving, and time management skills.
Exceptional attention to detail and ability to manage sensitive and confidential information.
Ability to work at a computer for extended periods, review electronic medical records and coding reports, and communicate effectively with providers and staff through phone, video conferencing, email, and Teams chat.
Ability to travel periodically to clinics.

Nice To Haves

Credentialing certification through NAMSS, including CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management).
Experience using credentialing software and provider enrollment databases.
Experience with Athenahealth.
Experience within a managed care, IPA, MSO, FQHC, medical group, or health plan environment.
Familiarity with provider network management and healthcare technology systems.

Responsibilities

Review, prepare, and submit provider credentialing, enrollment, and recredentialing applications for health plans, government programs, and healthcare organizations.
Manage provider enrollment and maintenance activities in CAQH, PECOS, NPPES, Medicare, Medicaid, and commercial payer portals.
Verify provider qualifications, including education, licensure, certifications, malpractice coverage, and other required documentation.
Maintain accurate credentialing records and monitor renewal timelines to ensure compliance and uninterrupted participation.
Ensure compliance with CMS, Medicare, Medicaid, NCQA, state, and health plan credentialing requirements.
Conduct ongoing exclusion monitoring, including OIG, SAM, and state exclusion screenings.
Research, resolve, and escalate credentialing issues, discrepancies, and payer-related concerns.
Assist with credentialing audits, provider inquiries, and health plan requests.
Partner with providers and internal departments to maintain accurate provider data and complete credentialing on time.
Prepare and provide credentialing status reports and updates to leadership.
Attend provider meetings, trainings, and market events as needed.