Credentialing Specialist

Credentialing SpecialistDepartment: Ops - CredentialingEmployment Type: Full TimeLocation: 1600 Corporate Center Dr., Monterey Park, CA 91754Reporting To: Nicole TurnerCompensation: $23.80 - $30.55 / hourDescriptionThis 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 DoReview 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 accreditationAssess completeness of information and provider's qualifications relative to established standardsDetermine appropriate verification and reference letters to be prepared for adequate processing of each individual application and reapplicationIdentify and flag adverse information from provider application materials for the purpose of conducting follow-up investigationsRequest facility site reviews from appropriate source (i.e. CalOptima, HealthNet, IEHP, etc) on applicable providersResponsible for completion of recredentialing files within 36-month timeframeUpdate new information as received via recredentialing process Maintain and exceed quantity and quality goals and standards set by the departmentQualificationsRequirement: High school diploma or equivalent1-2 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 ConditionsOur 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.

Created: 2026-04-02