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Manager - Credentialing Audit & Oversight
Manager - Credentialing Audit & OversightAstrana Health, Inc. • Monterey Park, CA, US
Manager - Credentialing Audit & Oversight

Manager - Credentialing Audit & Oversight

Astrana Health, Inc. • Monterey Park, CA, US
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Description

The Credentialing Audit and Oversight Manager is responsible for managing the initial credentialing, re-credentialing and the continuous credentialing processes for individual and organizational Providers; supervision of credentialing staff, maintenance of the integrity of Provider data and contracts in credentialing files, and in the credentialing database, compliance with regulatory and accreditation standards.

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

  • Facilitate regulatory audits, cooperating with credentialing Contract plans’ delegation oversight audits, and conducting internal audits.
  • Responsible for performance expectations related to compliance and credentialing quality control, delegation oversight of credentialing vendors, and departmental goals.
  • Collaborate with fellow leadership, co-workers, network providers, and staff in other departments to achieve departmental and organizational objectives and to deliver exceptional Provider Services.
  • Foster an environment of continuous learning, staff development, and performance improvement through defined metrics.

    • Qualifications

  • Bachelor’s degree in Health Care Administration or Business-related discipline or 4 years of related experience.
  • NAMSS Certification (CPCS or CPMSM) strongly preferred or eligibility to acquire within 12 months after date of hire as needed.
  • Four years of experience in the following areas : Hospital Credentialing, Health Plan Credentialing.
  • Two years of management experience in auditing and managing a credentialing department.
  • Two years of active collaboration experience with auditors.
  • Strong attention to detail, critical thinking, problem solving and analytical skills.
  • Demonstrated ability to work collaboratively, multi-task and meet deadlines in a complex, rapidly evolving environment with staff across the organization / departments.
  • Proficiency in MS Office suite.
  • Strong interpersonal, communication, organizational and time / project management skills are essential.
  • Excellent written and verbal communication skills.

    • Environmental Job Requirements and Working Conditions

  • This is a hybrid position. The home office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
  • The total compensation target pay range for this role is $90,000 - $120,000. The salary range represents our national target range for this role.

    • Astrana Health (NASDAQ : ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

    Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

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    Credentialing Manager • Monterey Park, CA, US

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