Astrana Health

Technology-enabled platform delivering value-based care

Credentialing Specialist

Clerical & Data EntryPosted on Nov 9

Full-timeBeaumont, TX, USA$19 - $25 /hrHybrid

About the Job

Requirements

A high school diploma or equivalent is required.
At least 2 years of provider credentialing experience within a physician practice, medical group, IPA, MSO, health plan, or managed care environment is required.
Experience with CAQH, PECOS, NPPES, Medicare enrollment and revalidation, Medicaid enrollment, and commercial payer credentialing processes is required.
Knowledge of credentialing standards, enrollment procedures, and healthcare regulatory requirements is required.
Experience working with electronic health records, practice management systems, and credentialing platforms is required.
Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook, is required.
Strong analytical, organizational, communication, problem-solving, and time management skills are required.
Attention to detail and the ability to manage sensitive and confidential information are required.

Responsibilities

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.

Desired Qualifications

Credentialing certification through NAMSS, including CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management).
Experience using credentialing software and provider enrollment databases.
Experience with Athenahealth.
Experience within a managed care, IPA, MSO, FQHC, medical group, or health plan environment.
Familiarity with provider network management and healthcare technology systems.

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

High school diploma or equivalent required
At least 2 years of provider credentialing experience within a physician practice, medical group, IPA, MSO, health plan, or managed care environment
Experience with CAQH, PECOS, NPPES, Medicare enrollment and revalidation, Medicaid enrollment, and commercial payer credentialing processes
Strong knowledge of credentialing standards, enrollment procedures, and healthcare regulatory requirements
Experience working with electronic health records, practice management systems, and credentialing platforms
Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook
Strong analytical, organizational, communication, problem-solving, and time management skills
Exceptional attention to detail and ability to manage sensitive and confidential information

Preferred Qualifications

Credentialing certification through NAMSS, including CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management)
Experience using credentialing software and provider enrollment databases
Experience with Athenahealth
Experience within a managed care, IPA, MSO, FQHC, medical group, or health plan environment
Familiarity with provider network management and healthcare technology systems

About the Company

Astrana Health

Technology-enabled platform delivering value-based care

Astrana Health runs a physician-focused, technology-enabled care platform that supports providers in delivering proactive, preventive, value-based care. Its end-to-end system coordinates care across affiliated networks, a management services organization, and primary, specialty, and ancillary clinics to help more than 20,000 providers and over 1.6 million Americans in value-based arrangements. How it works: the proprietary platform connects clinicians, patients, and care settings, enabling proactive care planning, care coordination, and efficient delivery of services in primary and specialty care. The company differentiates itself by combining a large provider network, an MSO, and clinics with a single tech platform to scale value-based care and improve patient experiences and outcomes rather than relying on fragmented, fee-for-service models. Its goal is to create a healthcare system that delivers better care, better experiences, and better outcomes for all.

Company size: 501-1,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Alhambra, CA
Founded: Not listed

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