Manager - Credentialing and Payor Enrollment

Astrana Health; Alhambra (CA); On-site; USD 80,000 - 100,000; Full time

Job summary

A healthcare organization in California is seeking a Manager - Credentialing and Provider Relations to oversee credentialing processes and enhance provider relations. The ideal candidate will have 2-3 years of credentialing experience, excellent communication skills, and proficiency in Microsoft Office. This role involves collaboration with various departments and requires travel within the service areas. The position offers a salary range of $80,000-$100,000 annually, following a hybrid work structure.

Qualifications

• Minimum 2-3 years experience in credentialing.
• Strong organizational skills needed.
• Must maintain reliable transportation.

Responsibilities

• Manage initial credentialing and re-credentialing processes.
• Collaborate with leadership and staff to deliver services.
• Develop relationships and maintain communication with providers.
• Lead activities related to provider marketing and growth.

Skills

Credentialing expertise

Excellent written and verbal communication

Proficient in Microsoft Office

Strong understanding of Managed Care Operations

Education

Bachelor’s degree or equivalent experience

NAMSS Certification (CPCS or CPMSM)

Job description

Overview

Astrana is seeking a Manager - Credentialing and Provider Relations to manage the credentialing/re-credentialing process for providers within our owned clinical entities, ranging from primary care, urgent care, specialty, and imaging centers. This manager will also contribute to provider relations by building rapport with providers in-person at our clinics. We are looking for credentialing experts who are highly organized, Excel-savvy, comfortable with paper credentialing processes, and eager to bring organization to a disorganized process. This is a great opportunity for candidates who enjoy having a large scope of responsibility, are self-starters, and are eager to make an impact on the lives of over 100 providers.

Responsibilities

• Manage the initial credentialing, re-credentialing, and continuous credentialing processes for individual and organizational providers. Manage the integrity of provider data and contracts in the credentialing files and database in compliance with regulatory standards
• Collaborate with leadership, co-workers, network providers, and staff in other departments to achieve objectives and deliver exceptional provider services
• Develop trusted relationships and maintain open lines of communication with providers through in-person visits, emails, and phone
• Collaborate with other departments to ensure provider inquiries are resolved in a timely and effective manner
• Participate and lead activities related to provider marketing and growth
• Create detailed reporting of provider visits, inquiries, trainings, and growth opportunities
• Problem-solve and identify ways to address provider issues timely and effectively
• Work cross-functionally with internal departments
• Must be able to travel to the assigned service areas
• Other duties assigned by department leaders

Qualifications

• Bachelor’s degree or equivalent years of experience preferred
• 2-3 years experience in credentialing
• NAMSS Certification (CPCS or CPMSM) strongly preferred
• Strong understanding of Managed Care Operations
• Excellent written and verbal communication skills
• Proficient computer skills and Microsoft Office programs (Outlook, Excel, Word, PowerPoint)

Working Conditions

• Our organization follows a hybrid work structure with in-office, clinic, and remote work on a weekly basis. The office is located at 1668 S Garfield, 2nd Floor, Alhambra CA 91801.
• This position requires traveling to provider offices throughout the San Gabriel Valley, Riverside, and Orange County. Travel may occur across regions and days; candidates must be willing to drive within these regions for provider relations and credentialing efforts
• Must maintain a reliable source of transportation
• Total compensation target pay range is $80,000-$100,000 annually; this salary range represents our national target range for this role

Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Hospitals and Health Care

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