Credentialing Specialist

Astrana Health, Inc. • Monterey Park, CA

14d • $24 - $31 • Hybrid

About The Position

This position is responsible for performing credentialing and recredentialing activities in accordance with Astrana Health’s Credentialing Policies, contracted health plan requirements, CMS regulations, applicable state laws, and NCQA accreditation standards.

Requirements

• High school diploma or equivalent
• 1-2 years of experience in credentialing, provider enrollment, contracting or similar field.

Nice To Haves

• CPCS or CPMSM certification
• 2-3 years’ credentialing experience within a managed care, hospital or CVO credentialing

Responsibilities

• Review practitioner and organizational provider credentialing and recredentialing applications for completeness
• Review and analyze credentialing documents, including education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, requests for clinical privileges, malpractice history, and accreditation
• Assess completeness of information and provider’s qualifications relative to established standards
• Determine appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplication
• Identify and flag adverse information from provider application materials for the purpose of conducting follow-up investigations
• Request facility site reviews from appropriate source (i.e. CalOptima, HealthNet, IEHP, etc) on applicable providers
• Responsible for completion of recredentialing files within 36-month timeframe
• Update new information as received via recredentialing process
• Maintain and exceed quantity and quality goals and standards set by the department

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED