Astrana Health
Credentialing Audit & Quality Specialist
Astrana Health, Monterey Park, California, us, 91756
Credentialing Audit & Quality Specialist
Location:
1600 Corporate Center Dr., Monterey Park, CA 91754
Compensation:
$26.00 - $28.00 / hour
The Credentialing Audit & Quality Specialist ensures healthcare providers are appropriately credentialed with health plans and regulatory agencies. This role maintains accurate records, submits applications, and ensures compliance with industry regulations, serving as the primary liaison between healthcare providers and health plans.
What You’ll Do
Review and process healthcare providers’ credentialing applications to ensure compliance with health plan participation requirements.
Verify providers’ professional qualifications, including education, licensure, and certifications.
Maintain and update credentialing records for all providers within the health plan network.
Submit credentialing applications to health plans for review and approval.
Monitor re-credentialing timelines, ensuring timely renewal of certifications, licenses, and memberships.
Ensure compliance with federal, state, and health plan-specific regulations and policies.
Collect required documentation from providers, including diplomas, licenses, certifications, and malpractice insurance.
Address and resolve discrepancies or issues encountered during the credentialing process.
Protect the confidentiality of sensitive provider and patient information.
Assist with audits and respond to health plan inquiries regarding credentialing status.
Collaborate with internal departments to resolve credentialing-related issues and maintain accurate data.
Qualifications
Bachelor’s degree in Business, Communications, Healthcare, or a similar field.
Proven experience in credentialing within a health plan or managed care setting.
Strong knowledge of credentialing procedures and regulatory standards for health plans.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Excellent organizational skills and attention to detail.
Ability to maintain confidentiality and manage sensitive information.
Effective written and verbal communication skills.
Preferred Qualifications
Certification from a credentialing organization (e.g., National Association of Medical Staff Services, NAMSS).
Experience using credentialing software or databases.
Familiarity with medical terminology and healthcare provider networks.
Environmental Job Requirements and Working Conditions
Hybrid work structure: onsite 2 days a week at the Monterey Park office; remote candidates considered.
Hourly pay range: $26–28/hr.
Seniority level:
Associate
Employment type:
Full-time
Job function:
Accounting/Auditing and Finance
Industry:
Hospitals and Health Care
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1600 Corporate Center Dr., Monterey Park, CA 91754
Compensation:
$26.00 - $28.00 / hour
The Credentialing Audit & Quality Specialist ensures healthcare providers are appropriately credentialed with health plans and regulatory agencies. This role maintains accurate records, submits applications, and ensures compliance with industry regulations, serving as the primary liaison between healthcare providers and health plans.
What You’ll Do
Review and process healthcare providers’ credentialing applications to ensure compliance with health plan participation requirements.
Verify providers’ professional qualifications, including education, licensure, and certifications.
Maintain and update credentialing records for all providers within the health plan network.
Submit credentialing applications to health plans for review and approval.
Monitor re-credentialing timelines, ensuring timely renewal of certifications, licenses, and memberships.
Ensure compliance with federal, state, and health plan-specific regulations and policies.
Collect required documentation from providers, including diplomas, licenses, certifications, and malpractice insurance.
Address and resolve discrepancies or issues encountered during the credentialing process.
Protect the confidentiality of sensitive provider and patient information.
Assist with audits and respond to health plan inquiries regarding credentialing status.
Collaborate with internal departments to resolve credentialing-related issues and maintain accurate data.
Qualifications
Bachelor’s degree in Business, Communications, Healthcare, or a similar field.
Proven experience in credentialing within a health plan or managed care setting.
Strong knowledge of credentialing procedures and regulatory standards for health plans.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Excellent organizational skills and attention to detail.
Ability to maintain confidentiality and manage sensitive information.
Effective written and verbal communication skills.
Preferred Qualifications
Certification from a credentialing organization (e.g., National Association of Medical Staff Services, NAMSS).
Experience using credentialing software or databases.
Familiarity with medical terminology and healthcare provider networks.
Environmental Job Requirements and Working Conditions
Hybrid work structure: onsite 2 days a week at the Monterey Park office; remote candidates considered.
Hourly pay range: $26–28/hr.
Seniority level:
Associate
Employment type:
Full-time
Job function:
Accounting/Auditing and Finance
Industry:
Hospitals and Health Care
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