Astrana Health, Inc.
Location
Monterey Park, California
Salary
$24 - $31 / HOUR
Perform credentialing and recredentialing activities for practitioners and organizations in compliance with health plan requirements and NCQA standards. Review provider applications, verify qualifications, and conduct follow-up investigations on adverse information.
Requires a high school diploma and 1-2 years of experience in credentialing or provider enrollment. CPCS or CPMSM certification and 2-3 years of experience in managed care or CVO environments are preferred.
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
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
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
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