Job Description

Job Description

Job Title: Contracting and Credentialing Specialist

Target Compensation Range: $25.00 - $30.00/hour, depending on the relevant qualifications and experience.

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY: The Credentialing Specialist is responsible for the credentialing life cycle processes for contracted providers.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Review and process initial credentialing and recredentialing applications across all service areas including obtaining information and following up on missing elements via email, telephone, or fax.
• Maintain recredentialing and revalidation statuses for existing providers for government and commercia payors.
• Maintain and update provider data in credentialing database via continuous data maintenance.
• Provide status reporting to MSO Administrator on all credentialing and recredentialing applications, and new contract requests.
• Collect and file required enrollment documentation from provider and health plans and update internal departments as necessary.
• Create repeatable workflows that capture data such as: initial enrollment, recredentialing, revalidations and demographic changes. Enter final status from partners such as denials, approvals, effective dates, and other relevant information.
• Monitor expiration dates of licenses and certification.
• Input and maintain contracting/credentialing database and keep detailed records and logs.
• Facilitate credentialing/PNO audit conducted by participated Health Plans.
• Configure credentialed and contracted providers in EZ-CAP database.
• Regular and consistent attendance.
• Other duties as assigned.

EDUCATION and/or EXPERIENCE :

• High School diploma or GED required.
• Bachelor's Degree in Healthcare Administration, Finance, Business Administration or related field or a combination of education and experience.
• 1 - 3 years of experience in a credentialing role within a health plan, IPA, or medical group strongly desired.
• Strong working knowledge of Medicare, Medicaid, and health plan credentialing required.
• Stellar critical thinking with the ability to independently research complex issues and work towards resolution.
• Communicate professionally with internal teams and external providers and groups.
• Strong working knowledge of MS Office including Word, Excel, and Outlook.

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off

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