Credentialing Specialist

Astrana Health; Monterey Park (CA); Hybrid; USD 80,000 - 100,000; Full time

Job summary

Astrana Health is looking for a Credentialing Specialist to manage the credentialing of healthcare providers. This role involves processing applications, maintaining records, and ensuring compliance with regulations. With a focus on detail and organization, you will act as a liaison between providers and health plans. The position offers a hybrid working structure with a competitive hourly wage.

Qualifications

• Bachelors degree in a related field required.
• Experience in credentialing preferred.
• Knowledge of regulatory standards is essential.

Responsibilities

• Review and process credentialing applications to ensure compliance.
• Verify providers’ professional qualifications, including education and licensure.
• Maintain and update credentialing records.

Skills

Organizational skills

Attention to detail

Written communication

Verbal communication

Proficiency in Microsoft Office

Education

Bachelors degree in Business, Communications, Healthcare, or similar field

Tools

Credentialing software

Database management systems

Job description

Join to apply for the Credentialing Specialist role at Astrana Health

1 week ago Be among the first 25 applicants

Join to apply for the Credentialing Specialist role at Astrana Health

Get AI-powered advice on this job and more exclusive features.

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Compensation: $24.00 - $26.00 / hour

Department: Ops - Credentialing

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Compensation: $24.00 - $26.00 / hour

Description

The Credentialing Specialist ensures healthcare providers are appropriately credentialed with health plans and regulatory agencies. This role involves maintaining accurate records, submitting applications, and ensuring compliance with industry regulations. As the primary liaison between healthcare providers and health plans, the coordinator ensures timely and efficient completion of credentialing processes.

What You'll Do

• Review and process healthcare providers’ credentialing applications to ensure compliance with health plan participation requirements.
• Verify providers’ professional qualifications, including education, licensure, and certifications.
• Maintain and update credentialing records for all providers within the health plan network.
• Submit credentialing applications to health plans for review and approval.
• Monitor re-credentialing timelines, ensuring timely renewal of certifications, licenses, and memberships.
• Ensure compliance with federal, state, and health plan-specific regulations and policies.
• Collect required documentation from providers, including diplomas, licenses, certifications, and malpractice insurance.
• Address and resolve discrepancies or issues encountered during the credentialing process.
• Protect the confidentiality of sensitive provider and patient information.
• Assist with audits and respond to health plan inquiries regarding credentialing status.
• Collaborate with internal departments to resolve credentialing-related issues and maintain accurate data
  
  
  

Qualifications

• Bachelors degree in Business, Communications, Healthcare, or similar field.
• Proven experience in credentialing within a health plan or managed care setting.
• Strong knowledge of credentialing procedures and regulatory standards for health plans.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Excellent organizational skills and attention to detail.
• Ability to maintain confidentiality and manage sensitive information.
• Effective written and verbal communication skills.
  
  

Preferred Qualifications:

• Certification from a credentialing organization (e.g., National Association of Medical Staff Services, NAMSS).
• Experience using credentialing software or databases.
• Familiarity with medical terminology and healthcare provider networks.
  
  
  

Environmental Job Requirements and Working Conditions

• Our organization follows an hybrid work structure where the expectation is to work onsite 2 days a week. This position will report to our Monterey Park office at 1600 Corporate Center Dr.
• The total pay range for this role is: $24-26/hr. This salary range represents our national target range for this role.
  

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at Astrana Health by 2x

Sign in to set job alerts for “Credentialing Specialist” roles.

Los Angeles, CA $69,000.00-$76,000.00 1 month ago

Monterey Park, CA $19.00-$20.00 1 week ago

Credentialing Coordinator/Scheduler Assistant

Orange, CA $73,000.00-$76,000.00 1 month ago

Staffing Coordinator - Nursing Admin - Full Time 12 Hour Days (Non-Exempt) (Non-Union)

Medical Staff Office Specialist III - Credentialing

Los Angeles Metropolitan Area 1 month ago

Medical Staff Credentialing Coordinator PD - Per Diem 8 Hours Day (Non-Exempt, Non-Union)

Administrative Assistant, Human Resources

Workplace Experience Coordinator-Mobile Associate

Los Angeles Metropolitan Area $25.00-$26.00 2 weeks ago

Beverly Hills, CA $22.00-$24.00 1 week ago

Los Angeles Metropolitan Area $21.00-$23.75 1 month ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.