• Credentialing Analyst - UPMC Washington, WPHO

    UPMC (Washington, PA)


    _Join Our Team as a Credentialing Analyst! Are you detail-oriented and passionate about ensuring healthcare excellence? Our hospital is seeking a dedicated Credentialing Analyst to join our team. In this role, you will play a crucial part in maintaining the highest standards of patient care by verifying and managing the credentials of our medical staff._

    Responsibilities:

    + Provide support to Data Management including but not limited to: spreadsheet maintenance, license, degree and insurance product data query in contract and credentialing

    + Demonstrate knowledge of state, federal, and NCQA regulations concerning credentialing.

    + Provide back up for other Credentialing Analysts and to the Credentialing Team as assigned by the Credentialing Supervisor.

    + Utilize NPDB, and the federal cumulative sanction software for credentialing.

    + Initiate and maintain fluid communication with individual providers being credentialed.

    + Maintain complete and accurate records regarding credentialing/re-credentialing for practitioners or facilities as assigned.

    + Prioritize work assignments related to credentialing processes to ensure timely completion with satisfactory results.

    + Initiate consultation with the Medical Director or designee when provider specific information warrants, to include but not limited to NPDB queries, Act 33 & 34, claims histories, licensure, references.

    + Maintain confidentiality concerning queries through all credentialing processes.

    + Track expired data for providers and follow-up appropriately including state licensure, professional references, NPDB, etc.

    + Communicate with Network Management and Contracting regarding providers presenting problems with completing initial credentialing/re-credentialing.

    + High school diploma or equivalent required.

    + Experience in credentialing preferred.

    + Excellent written/verbal communication skills.

    + Ability to gather and manipulate data accurately and consistently.

    + Strong organizational skills & attention to detail.

    + Ability to manage multiple task and be flexible to the daily needs of the organization.

    + Computer competence.

    Licensure, Certifications, and Clearances:

    + Act 31 Child Abuse Reporting

    + Act 33

    + Act 34

    + Act 73 FBI Clearance

     

    UPMC is an Equal Opportunity Employer/Disability/Veteran