Credentialing Analyst - Hybrid

UPMC•Pittsburgh, PA

3d•Hybrid

About The Position

UPMC Community Care Behavioral Health is hiring a full-time Credentialing Analyst to handle credentialing duties and ensure the accurate completion and maintenance of credentialing files. The analyst manages files through the entire credentialing process, including interacting with external agencies for primary source verification (PSV) and bringing file-related problems to the Credentialing Supervisor’s attention. The team is headquartered in downtown Pittsburgh at the U.S. Steel Tower. This position follows a hybrid model, with in-office work on Monday, Wednesday, and Thursday.

Requirements

High school diploma or equivalent.
Excellent written and verbal communication skills.
Ability to gather and manipulate data accurately and consistently.
Strong organizational skills.
Ability to manage multiple tasks and adapt to the organization's daily needs.
Computer competence.
Attention to detail.

Nice To Haves

Two years of experience in healthcare, such as credentialing, enrollment, claims, or medical billing, or related areas.
Alternatively, strong experience in administration, legal support, data entry, project management, HR onboarding, quality, auditing, or similar fields.

Responsibilities

Provide support to Data Management, including spreadsheet maintenance and license, degree, and insurance product data queries in contract and credentialing.
Demonstrate knowledge of state, federal, and NCQA regulations concerning credentialing.
Complete provider complaint documentation.
Identify problems or issues associated with the credentialing process.
Coordinate site visit completion with the Credentialing Analyst responsible for that task.
Use the Provider at Risk list to identify provider files requiring urgent attention.
Complete data entry with 95% accuracy.
Provide backup for other Credentialing Analysts and the Credentialing Team as assigned by the Credentialing Supervisor.
Use Equifax, NPDB, and federal cumulative sanction software for credentialing.
Initiate and maintain fluid communication with individual providers being credentialed.
Maintain complete and accurate credentialing and re-credentialing records for assigned practitioners or facilities.
Prioritize credentialing work assignments to ensure timely completion and satisfactory results.
Consult with the Chief Medical Officer or designee when provider-specific information warrants it, including NPDB queries, Act 33 and 34, claims histories, licensure, and references.
Maintain confidentiality concerning queries throughout credentialing processes.
Track expired provider data and follow up appropriately, including state licensure, professional references, and NPDB information.
Communicate with Network Management and Contracting about providers having problems completing initial credentialing or re-credentialing.
Complete the PsychConsult Network Credentialing Manager checklist for all assigned practitioners under review.
Enter provider data into PsychConsult Network Credentialing Manager and PSV Manager.