Job Description

Credentialing Specialist

Department: Clinic Operations

Employment Type: Full Time

Location: 2929 Calder Ave, Beaumont, TX 77701

Reporting To: Maya Minard

Compensation: $19.00 - $25.00 / hour

Description

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

What You'll Do

• 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

Qualifications

• 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

Environmental Job Requirements and Working Conditions

• This role follows a remote work structure with periodic travel required to our clinics.
• Must be able to work at a computer for extended periods, review electronic medical records and coding reports, and communicate effectively with providers and staff via phone, video conferencing, email, and Teams chat.
• Ability to attend provider meetings, trainings, and market events as needed.
• The target pay range for this role is $19 - $25 per hour. Actual compensation will be determined based on geographic location, experience, qualifications, internal equity, and other job-related factors.