Credentialing Specialist

Credentialing SpecialistWe are currently seeking a highly motivated Credentialing Specialist to support our Clinic Operations team at Astrana Health. This role is responsible for ensuring healthcare providers are appropriately credentialed and enrolled with health plans, government programs, and regulatory agencies. The Credentialing Specialist serves as a key liaison between providers, health plans, and internal stakeholders to ensure timely and accurate completion of credentialing and enrollment processes. This position plays a critical role in maintaining compliance, supporting provider network integrity, and ensuring accurate provider data across multiple systems and payer platforms. The ideal candidate is highly organized, detail-oriented, and experienced in provider credentialing, enrollment, and regulatory compliance within a healthcare environment.Our ValuesPut Patients FirstEmpower Entrepreneurial Provider and Care TeamsOperate with Integrity & ExcellenceBe InnovativeWork As One TeamWhat You'll DoReview, prepare, and submit provider credentialing, enrollment, and recredentialing applications for health plans, government programs, and healthcare organizationsManage provider enrollment and maintenance activities within CAQH, PECOS, NPPES, Medicare, Medicaid, and commercial payer portalsVerify provider qualifications, including education, licensure, certifications, malpractice coverage, and other required documentationMaintain accurate credentialing records and monitor renewal timelines to ensure compliance and uninterrupted participationEnsure compliance with CMS, Medicare, Medicaid, NCQA, state, and health plan credentialing requirementsConduct ongoing exclusion monitoring, including OIG, SAM, and state exclusion screeningsResearch, resolve, and escalate credentialing issues, discrepancies, and payer-related concernsAssist with credentialing audits, provider inquiries, and health plan requestsPartner with providers and internal departments to maintain accurate provider data and timely credentialing completionPrepare and provide credentialing status reports and updates to leadershipQualificationsHigh school diploma or equivalent requiredAt least 2 years of provider credentialing experience within a physician practice, medical group, IPA, MSO, health plan, or managed care environmentExperience with CAQH, PECOS, NPPES, Medicare enrollment and revalidation, Medicaid enrollment, and commercial payer credentialing processesStrong knowledge of credentialing standards, enrollment procedures, and healthcare regulatory requirementsExperience working with electronic health records, practice management systems, and credentialing platformsProficiency with Microsoft Office Suite, including Word, Excel, and OutlookStrong analytical, organizational, communication, problem-solving, and time management skillsExceptional attention to detail and ability to manage sensitive and confidential informationPreferred QualificationsCredentialing certification through NAMSS, including CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management)Experience using credentialing software and provider enrollment databasesExperience with AthenahealthExperience within a managed care, IPA, MSO, FQHC, medical group, or health plan environmentFamiliarity with provider network management and healthcare technology systemsEnvironmental Job Requirements and Working ConditionsThis role follows a remote work structure with periodic travel required to our clinics.Must be able to work at a computer for extended periods, review electronic medical records and coding reports, and communicate effectively with providers and staff via phone, video conferencing, email, and Teams chat.Ability to attend provider meetings, trainings, and market events as needed.The target pay range for this role is $19 - $25 per hour. Actual compensation will be determined based on geographic location, experience, qualifications, internal equity, and other job-related factors.About Astrana Health, Inc.Astrana Health (NASDAQ: ASTH) 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 to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.Our platform currently empowers over 20,000 physicians to provide care for over 1.7 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 to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.