Supervisor - Credentialing

Supervisor - Credentialing

Department: Ops - Credentialing

Employment Type: Full Time

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Reporting To: Nicole Turner

Compensation: $67,358 - $86,443 / year

Responsible for the supervision of staff and assisting with the credentialing/recredentialing of all providers managed by Astrana Health Management by following NCQA standards, Astrana policies and procedures and all contracted health plan requirements.

• Credentialing Operations & Oversight Lead and oversee the full credentialing lifecycle, including initial credentialing, recredentialing, expirables, and renewals for Practitioners and HDOs
• Ensure credentialing files are complete, accurate, properly maintained, and stored in the credentialing system
• Review and resolve credentialing discrepancies and escalated issues to prevent delays or compliance risks
• Ensure uninterrupted credentialing status by proactively managing renewals and monitoring expirations

• Ensure ongoing compliance with regulatory agencies, accreditation standards (e.g., NCQA), health plan requirements, and internal policies
• Oversee quality review of credentialing files and ensure audit readiness at all times. Participate in and support health plan audits, investigations, and corrective action responses as needed
• Assist with preparation of Peer Review Committee materials and oversight of peer review monitoring and follow-up Leadership & Staff Management
• Provide active supervision of credentialing staff, including work allocation, training, coaching, performance management, and enforcement of internal procedures and controls
• Conduct annual performance reviews, approve timecards, and address performance or workflow issues promptly
• Establish, document, and track departmental goals, projects, and key performance indicators (KPIs)

• Ensure accuracy, integrity, and functionality of the credentialing database
• Monitor automated workflows, reports, and system configurations; identify and implement optimizations as needed
• Research and recommend tools, technologies, and process improvements to enhance department efficiency and effectiveness

• Prepare and present credentialing, productivity, compliance, and performance reports for senior leadership and governance forums, including Joint Operations Meetings
• Serve as the credentialing department representative when working with internal stakeholders and external partners
• Collaborate with Provider Relations, Contracting, Compliance, and external credentialing contacts to resolve issues and ensure a seamless credentialing process

• Stay current with industry best practices, regulatory changes, and emerging trends in healthcare credentialing
• Proactively recommend improvements to policies, workflows, and controls to reduce risk and improve turnaround times

• 3+ years of experience in credentialing, with at least 1-2 years in a supervisory or leadership role
• Knowledge of healthcare accreditation standards (e.g., NCQA) and regulatory requirements
• Strong organizational skills and attention to detail
• Excellent communication and interpersonal skills
• Ability to handle confidential information with discretion and integrity
• Proficiency in credentialing software and Microsoft Office Suite
• Strong problem-solving skills and ability to work under pressure
• Certification in credentialing (e.g., CPCS or CPMSM) preferred

• Our 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 $67,358.46 - $86,443.36. 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.