Astrana Health Careers

Description

Job Title: Senior Manager, Credentialing
Department: Operations – Credentialing

About the Role:

The Senior Manager of Credentialing role is a leadership role with ownership, accountability and oversight of the Credentialing department as it pertains to employed and contracted providers for Astrana. S/he will be a results-driven leader who thrives in a fast-paced environment with a proven track record of building successful teams and managing the end-to-end provider lifecycle process. The successful candidate will be an effective change agent who has demonstrated success in taking on new challenges and executing projects that will enable further growth of the owned and managed IPA’s and medical groups. This individual will have a high capacity for GSD (get stuff done) and model the company’s core values and commitment to supporting providers in transitioning to value-based care and transforming healthcare delivery, especially in underserved communities. This role reports to the Senior Director of Credentialing.

What you’ll do:

• Manage team and lead the day-to-day operations of the Credentialing teams to ensure SLAs are being met
• Build sound professional relationships with key stakeholders.
• Partner with PR, Market Leaders and proactively manage provider data to avoid provider teems and abrasion
• Reporting as required for credentialing for all states and IPAs
• Help develop plan for NCQA certification for Astrana to become a CVO
• Credentialing function follows NCQA and payer standards
• Credentialing, monitoring, and other tangential services are fulfilled in an efficient and accurate manner for our IPAs, clinics and clients
• Develop short / long term goals and establish standards for turnaround times; implement action plans and monitoring processes to achieve those goals
• Identify opportunities to continuously improve the end-to-end credentialing and payer enrollment processes
• Take data-driven approach and proactively lead process improvement opportunities in collaboration with applicable stakeholders (e.g., IT, software engineering, contracting, etc.) to ensure processes and workflows are streamlined, scalable and compliant
• Goal is to continuously improve and exceed industry standards for Credentialing and provider enrollment processing time and accuracy
• Clean up all backlogs for the provider apps, missing data
• Demonstrate service excellence mindset to all clients and ensure all client issues and concerns are reviewed, analyzed and responded to in a timely manner
• Oversee the onboarding of new providers and maintains a strong relationship with existing ones
• Assist providers with their application process and maintain all their expirables
• Maintains a thorough and working knowledge of credentialing industry standards such as NCQA, the Joint Commission, URAC, etc.
• Ensure the department’s policies and procedures are regularly updated and maintained to align with accreditation standard and operating procedures
• Leadership presence for team and help drive results by collaborating with all stakeholders
• Help build repeatable and scalable tools, templates
• Develop, track and measure applicable KPI’s, SLAs and other leading indicators for ops
• Continuously review business processes, manage change, and incorporate process improvement. Be the change agent
• Manage any special and/or ad-hoc projects related to growth

Required Qualifications:

• Bachelor’s degree in business administration, health administration or related field
• CPMSM or CPSC professional certification
• 10+ years of credentialing operations experience; 5+ years of supervising/leading a credentialing department, credentialing verification organization (CVO) and/or provider enrollment teams
• Possess detailed understanding of provider enrollment and credentialing operations with 5+ years of credentialing system experience
• Subject matter expert on NCQA, URAC, The Joint Commission, and other relevant credentialing standards and accreditations
• Demonstrated ability to ingest and present data, design and implement agile processes, and manage competing priorities
• Ability to effectively follow through and drive projects through completion in a dynamic, matrixed environment with a high degree of organizational change, growth and ambiguity
• Solid history of quickly gaining credibility, partnering with business leaders and provider, and exhibiting executive presence

Preferred qualifications:

• MBA or Master’s degree
• Managing a CVO through an NCQA accreditation survey
• Extensive experience with managed care organizations (e.g., medical group operations, IPA’s, etc.)
• Resourcefulness—the ability to find and implement effective solutions despite time or resource constraints
• Sound judgement, ability to analyze situations and information, problem solver
• Ability to work independently with little guidance, as well as collaboratively in a collegial environment with business team members and external stakeholders

Who We Are:

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 10,000 physicians to provide care for over 1 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.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

Environmental Job Requirements and Working Conditions:

• Our organization follows a hybrid work structure where the expectation is to work both in the office and at home on a weekly basis. The office is located at 1600 Corporate Center Drive Monterey Park, CA 91754
• The total compensation target pay range for this role is between 110-130K. This salary expectation represents our national target range for this role.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.