Job Information
UPMC Sr. Credentials Analyst in Pittsburgh, Pennsylvania
UPMC Health Plan is hiring a full-time Sr. Credentials Analyst to support the National Network Management team. This role will predominantly work remotely with occasional in-person attendance required in the office in downtown Pittsburgh.
This position will ensure that the provider files comply with UPMC Health Plan (UPMC HP) credentials standards prior to submission to the Credentials Committee. They will also assist in maintaining department compliance with all governing bodies.
Responsibilities:
Complete primary source verification information, including: verification of applicant's license, board certification, hospital privileges, malpractice history, residencies, graduate medical education.
Prepare provider files for credentialing and re-credentialing within 180 days of the provider's signature on the application according to UPMC HP policies and procedures.
Update credentials data in Health Plan databases according to department standards.
Forward a copy of the approval letters of providers in PHO's to the respective PHO Executive Directors and retain a copy in a secure area.
Obtain copies of DEA certificate, CME certificates and malpractice insurance face sheet.
Scan file documents in the provider file after Credentials Committee approval and as updated documents are received into P8 Filenet.
Training of new staff members in the credentialing processes to ensure compliance with all regulatory bodies
Check for sanctions using appropriate verification sources.
Ensure customer service to both internal and external customers.
Create approval letter merge for all approved credentials files both initial and recredential and forward welcome letters to providers in a timely manner. File a copy of the welcome letter and provider profile in the provider's credentials file to be scanned into P8 Filenet
Responsible to Credentials Supervisor to evaluate training progress of new staff members.
Prepare the packets for the monthly Credentials Committee meeting.
Attend meetings between departments related to Credentials Dept. as needed.
Review credentials/recredentials applications for completeness. Written and verbal communication with provider to obtain information necessary to complete application.
Interface and respond promptly, courteously and accurately to credentials questions from UPMC HP departments, UPMC HP providers and UPMC HP PHO/PO affiliates.
High School diploma required. Associate degree in business or healthcare. (Related experience may be substituted for educational requirements.)
Four years' experience in credentialing required.
Demonstrated experience in NCQA compliance in credentialing required.
Computer efficiency in database entry, Excel, word processing and report generating essential.
Five years of data entry experience preferred.
Excellent written and verbal communication skills required.
High degree of organizational skills with excellent problem-solving skills required.
Demonstrated performance in meeting deadlines required. Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran