Credentialing Analyst - UPMC Washington, WPHO
UPMC
_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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