Credentialing Analyst - Hybrid

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 42,000 - 64,000; Full time

Job summary

UPMC Community Care Behavioral Health is seeking a full-time Credentialing Analyst. The role is based in downtown Pittsburgh within the U.S. Steel Tower and operates in a hybrid model with in-office days on Monday, Wednesday, and Thursday.

The Credentialing Analyst will manage credentialing files and oversee the entire process, coordinating with external agencies and the Credentialing Supervisor. You will support Data Management, maintain regulatory knowledge, ensure high-accuracy data entry,

Responsibilities

• Provide support to Data Management including spreadsheet maintenance and data queries in contract and credentialing.
• Demonstrate knowledge of state, federal, and NCQA regulations concerning credentialing.
• Complete provider complaint documentation.
• Identify problems/issues associated with the credentialing process.
• Coordinate site visit completion with the Credentialing Analyst responsible for this task.
• Utilize the Provider at Risk list to identify provider files requiring urgent attention.
• Complete data entry with high accuracy.
• Provide back up for other Credentialing Analysts and to the Credentialing Team as assigned by the Credentialing Supervisor.
• Utilize Equifax, 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.
• Prioritize work assignments related to credentialing processes to ensure timely completion with satisfactory results.
• Initiate consultation with the Chief Medical Officer or designee when provider specific information warrants, including 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.
• Complete PsychConsult Network Credentialing Manager checklist for all practitioners assigned for review.
• Enter provider data into PsychConsult Network Credentialing Manager and PSV Manager.

Job description

UPMC Community Care Behavioral Health is hiring a full-time Credentialing Analyst. The team is headquartered in downtown Pittsburgh at the U.S. Steel Tower. This position will work in a hybrid model, with a few in office days each week - Monday, Wednesday and Thursday.

The Credentialing Analyst will handle credentialing duties within Community Care. They ensure the accurate completion and maintenance of credentialing files. They take files for credentialing through the entire process including interacting with external agencies for PSV and bringing problems about a particular file to the attention of the Credentialing Supervisor.

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.
• Complete provider complaint documentation.
• Identify problems/issues associated with the credentialing process.
• Coordinate site visit completion with Credentialing Analyst responsible for this task.
• Utilize the Provider at Risk list to assist to identify provider files requiring urgent attention.
• Complete data entry at 95% accuracy.
• Provide back up for other Credentialing Analysts and to the Credentialing Team as assigned by the Credentialing Supervisor.
• Utilize Equifax, 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 Chief Medical Officer 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.
• Complete PsychConsult Network Credentialing Manager checklist for all practitioners assigned for review.
• Enter provider data into PsychConsult Network Credentialing Manager and PSV Manager.