Job Description

Department: Ops - Credentialing

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

Compensation: $23.80 - $30.55 / hour

Description

This position is responsible for performing credentialing and recredentialing activities in accordance with Astrana Health’s Credentialing Policies, contracted health plan requirements, CMS regulations, applicable state laws, and NCQA accreditation standards.

What You'll Do

• Review practitioner and organizational provider credentialing and recredentialing applications for completeness
• Review and analyze credentialing documents, including education, residency and fellowship training, board certification and eligibility, licensure, professional work history, liability insurance, requests for clinical privileges, malpractice history, and accreditation
• Assess completeness of information and provider’s qualifications relative to established standards
• Determine appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplication
• Identify and flag adverse information from provider application materials for the purpose of conducting follow-up investigations
• Request facility site reviews from appropriate source (i.e. CalOptima, HealthNet, IEHP, etc) on applicable providers
• Responsible for completion of recredentialing files within 36-month timeframe
• Update new information as received via recredentialing process
• Maintain and exceed quantity and quality goals and standards set by the department

Qualifications

Requirement:

• High school diploma or equivalent
• 1-2 years of experience in credentialing, provider enrollment, contracting or similar field.

You're great for the role if:

• Licensure, Certification, Registration: CPCS or CPMSM certification
• 2-3 years’ credentialing experience within a managed care, hospital or CVO credentialing

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754.
• The target pay range for this role is between $23.80 - $30.55 per hour. This salary range represents our national target range for this role. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
  

Job Tags

Hourly pay, Work at office

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