About this role
About the Role
We 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 Values Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team Review, prepare, and submit provider credentialing, enrollment, and recredentialing applications for health plans, government programs, and healthcare organizations Manage provider enrollment and maintenance activities within CAQH, PECOS, NPPES, Medicare, Medicaid, and commercial payer portals Verify provider qualifications, including education, licensure, certifications, malpractice coverage, and other required documentation Maintain accurate credentialing records and monitor renewal timelines to ensure compliance and uninterrupted participation Ensure compliance with CMS, Medicare, Medicaid, NCQA, state, and health plan credentialing requirements Conduct ongoing exclusion monitoring, including OIG, SAM, and state exclusion screenings Research, resolve, and escalate credentialing issues, discrepancies, and payer-related concerns Assist with credentialing audits, provider inquiries, and health plan requests Partner with providers and internal departments to maintain accurate provider data and timely credentialing completion Prepare and provide credentialing status reports and updates to leadership