Supervisor - Credentialing

Astrana Health, Inc.•Monterey Park, CA

4d•Hybrid

About The Position

Responsible for the supervision of staff and assisting with the credentialing/recredentialing of all providers managed by Astrana Health Management by following NCQA standards, Astrana policies and procedures and all contracted health plan requirements.

Requirements

3+ years of experience in credentialing, with at least 1-2 years in a supervisory or leadership role
Knowledge of healthcare accreditation standards (e.g., NCQA) and regulatory requirements
Strong organizational skills and attention to detail
Excellent communication and interpersonal skills
Ability to handle confidential information with discretion and integrity
Proficiency in credentialing software and Microsoft Office Suite
Strong problem-solving skills and ability to work under pressure

Nice To Haves

Certification in credentialing (e.g., CPCS or CPMSM) preferred

Responsibilities

Lead and oversee the full credentialing lifecycle, including initial credentialing, recredentialing, expirables, and renewals for Practitioners and HDOs
Ensure credentialing files are complete, accurate, properly maintained, and stored in the credentialing system
Review and resolve credentialing discrepancies and escalated issues to prevent delays or compliance risks
Ensure uninterrupted credentialing status by proactively managing renewals and monitoring expirations
Ensure ongoing compliance with regulatory agencies, accreditation standards (e.g., NCQA), health plan requirements, and internal policies
Oversee quality review of credentialing files and ensure audit readiness at all times. Participate in and support health plan audits, investigations, and corrective action responses as needed
Assist with preparation of Peer Review Committee materials and oversight of peer review monitoring and follow-up
Provide active supervision of credentialing staff, including work allocation, training, coaching, performance management, and enforcement of internal procedures and controls
Conduct annual performance reviews, approve timecards, and address performance or workflow issues promptly
Establish, document, and track departmental goals, projects, and key performance indicators (KPIs)
Ensure accuracy, integrity, and functionality of the credentialing database
Monitor automated workflows, reports, and system configurations; identify and implement optimizations as needed
Research and recommend tools, technologies, and process improvements to enhance department efficiency and effectiveness
Prepare and present credentialing, productivity, compliance, and performance reports for senior leadership and governance forums, including Joint Operations Meetings
Serve as the credentialing department representative when working with internal stakeholders and external partners
Collaborate with Provider Relations, Contracting, Compliance, and external credentialing contacts to resolve issues and ensure a seamless credentialing process
Stay current with industry best practices, regulatory changes, and emerging trends in healthcare credentialing
Proactively recommend improvements to policies, workflows, and controls to reduce risk and improve turnaround times