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UPMC Revenue Cycle is hiring a Credentialing Coordinator. As a Credentialing Coordinator, you will be responsible for processing applications and performing primary source verification for applicants to the facilities and organizations of UPMC. You will process applications and perform primary source verification for reappointment and re-credentialing for practitioners who are members of the facilities and organizations of the UPMC.

The Credentialing Coordinator role will work Monday through Friday from the Quantum One building in Pittsburgh, PA with the potential for some work from home after training.

Responsibilities:

+ Performs data entry and scans accurately and efficiently according to established policies, procedures and guidelines.

+ Completes files efficiently, according to policy and within the established standards and guidelines.

+ Maintains excellent communication (verbal, written and electronic) with all customers of the CVO including, but not limited to, the practitioners and the entity users.

+ Processes applications expeditiously and efficiently according to the established priorities and timeframes.

+ Performs primary source verification, records information received and provides follow up as necessary according to established policies and procedures.

+ Assists with database integrity and maintenance

+ Ability to work independently with minimal supervision

+ Ability to work multiple payers

+ Demonstrate knowledge of the current functionality of the patient accounting systems.

+ Identify root cause issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials. Assist in claim appeal process and/or perform follow-up in accordance with Revenue Cycle policies and procedures.

+ Managed assigned book of business by ensuring the timeliness and accuracy of billing, collections, contractual postings, payments and adjustments of accounts based upon their functional area standards.

+ Meet quality assurance benchmark standards and maintain productivity levels as defined by management.

+ High School Diploma or equivalent and 2 years of work experience required

+ Excellent data entry and computer software application skills required

+ Desire to maximize the use of technology to automate processes.

+ Detail-oriented person with excellent communication and interpersonal skills required.

+ Prior credentialing experience is preferred.

+ Experience with both JCAHO and NCQA standards is preferred.

+ Experience with registration, charge entry, payment posting, and billing highly preferred

+ Knowledge of Electronic Data Interchange format and Provider and Enrollment Credentialing guidelines highly preferred

+ Experience with EPIC billing system is highly preferred

+ Post-secondary education in healthcare or business related field is preferred.

+ Current knowledge of ICD-10, CPT and HCPCS coding

+ Awareness of compliance and HIPAA guidelines as related to billing office functions.

+ Working knowledge of Microsoft Word and Excel.

Licensure, Certifications, and Clearances:

+ ACT 34

UPMC is an Equal Opportunity Employer/Disability/Veteran