Credentialing Specialist

1 month ago

Monterey, United States Astrana Health Full time
Description

Job Title: Credentialing Specialist
Department: Operations - Credentialing

About the Role:

We are currently seeking a highly motivated Credentialing Specialist. This role will report to the Supervisor - Credentialing and enable us to continue to scale in the healthcare industry. The Credentialing Specialist fulfills all activities required for successful completion of initial and re-credentialing applications. Key responsibilities include Credentialing Committee preparation and scheduling, responding to health plan credentialing audits, and successful integration of credentialing files for newly acquired entities. This is a hybrid/remote role where the expectation is to work both in office and at home on a weekly basis (dependent on the employee's location).

What You'll Do:
  • Process initial and reappointment credentialing applications and conduct follow up as needed
  • Quality spot check applications before submission to committee
  • Prepare monthly reports for peer review/credentialing committee meetings
  • Input all credentialing data into credentialing software database accurately and timely
  • Work closely with IPAs and Hospitals to ensure exceptional customer service
  • Maintain provider state licenses, DEA certificates, malpractice insurance and any other required credentialing documents
  • Represents the MSO while interacting with internal and external contacts
  • Remain up to date with credentialing accreditation standards with NCQA and Joint Commission
  • Knowledge of current credentialing standards published by Joint Commission and/or NCQA
  • Ability to analyze complex application problems and provide solutions
  • Ability to work with multiple projects and deadlines
  • Excellent written and verbal communication skills
  • Detail oriented and possess strong organizational skills in a fast-pace environment
Qualifications:
  • High School Diploma
You're great for this role if:
  • Bachelor's Degree
  • Licensure, Certification, Registration: CPCS or CPMSM certification
  • 2-3 years' credentialing experience within a managed care, hospital or CVO credentialing
Who We Are:

Astrana Health (NASDAQ: AMEH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 10,000 physicians to provide care for over 1.2 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Our Values:
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity and Excellence
  • Be Innovative
  • Work as One Team
Environmental Job Requirements and Working Conditions:
  • This position is hybrid. The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
  • The total compensation target pay range for this role is: $22.00 to $28.00 per hour. The salary range represents our national target range for this role.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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