Washington, PA, 15301, USA
5 days ago
Credentialing Analyst - UPMC Washington, WPHO
_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**
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