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Provider Enrollment Specialist

Provider Enrollment Specialist

Astrana Health, Inc.Las Vegas, Nevada, US
5 days ago
Job type
  • Full-time
  • Quick Apply
Job description

Description

We are seeking a highly organized and detail-oriented Provider Enrollment Specialist to support accurate and efficient revenue cycle operations. This role plays a key part in maintaining and updating credentialing records for all providers within the health plan networks. The ideal candidate has experience in both fee-for-service and value-based care billing and credentialing environments, understands risk-adjusted payment models, and is committed to compliance, accuracy, and process improvement.

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

  • Prepare, review, and submit clean medical claims for primary and secondary payers, including Medicare Advantage, Medicaid Managed Care, and commercial insurers.
  • Maintain a strong understanding of payer policies, VBC metrics, RAF / HCC coding relevance, and risk adjustment impacts on reimbursement.
  • Support audits, data clean-up initiatives, and quality reporting related to billing.
  • Ensure compliance with HIPAA and all regulatory requirements.
  • Review and process healthcare providers’ credentialing applications to ensure compliance with health plan participation requirements.
  • Verify providers’ professional qualifications, including education, licensure, and certifications.
  • Maintain and update credentialing records for all providers within the health plan network.
  • Submit credentialing applications to health plans for review and approval.
  • Monitor re-credentialing timelines, ensuring timely renewal of certifications, licenses, and memberships.
  • Ensure compliance with federal, state, and health plan-specific regulations and policies.

    • Qualifications

  • High school diploma or equivalent required; associate degree or billing certification (e.g., CPB, CMRS) preferred.
  • 2+ years of medical billing experience in a multi-specialty or primary care setting.
  • Experience with Medicare Advantage, HMO, PPO, and / or value-based payment models strongly preferred.
  • Familiarity with EMR and billing software (e.g., eClinicalWorks, Athena, NextGen, Kareo).
  • Working knowledge of CPT, ICD-10, HCPCS, and modifier usage.
  • Strong attention to detail, organizational skills, and follow-through.
  • Excellent communication and teamwork skills.

    • Environmental Job Requirements and Working Conditions

  • Our organization follows an in-person work structure where the expectation is to work onsite 2-3 days a week. This position will report to our corporate office at 8880 W Sunset Rd, Suite 320, Las Vegas, NV 89148.
  • The total pay range for this role is : $20-23 per hour. This salary range represents our national target range for this role.

    • About Astrana Health, Inc.

    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.

    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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    Provider Enrollment Specialist • Las Vegas, Nevada, US