Credentials Analyst HPL

UPMC (old); Pittsburgh (Allegheny County); Hybrid; USD 55,000 - 75,000; Full time

Job summary

UPMC Health Plan in Pittsburgh is seeking a Credentials Analyst HPL in the National Network Management department. This full-time, hybrid role requires in-office presence Monday, Wednesday, and Thursday, with duties to manage credentialing and recredentialing for direct contracted providers.

You will coordinate primary source verifications, maintain databases, communicate with providers and internal teams, and prepare files for the Credentials Committee, ensuring timely updates and accuracy.

Job description

UPMC Health Plan has an exciting opportunity for aCredentials Analyst HPL position in the National Network Management department. This is a full time, hybrid position with in-office work required Monday, Wednesday, and Thursday.

Purpose

To ensure that the provider files comply with UPMC Health Plan (UPMC HP) credentials standards prior to submission to the Credentials Committee. Assist in maintaining department compliance with all governing bodies. Credentialing Analyst is responsible for coordinating the timely Credentialing activities that are necessary to support the credentialing and recredentialing of UPMC Health Plan (UPMC HP) direct contracted providers and to provide support to the UPMC HP Network staff. Assists with data base maintenance and integrity.

Responsibilities

• Review credentials/recredentials applications for completeness.
• Written and verbal communication with provider to obtain information necessary to complete application.
• Ensure customer service to both internal and external customers.
• Respond promptly, courteously and accurately to credentials questions from UPMC HP departments, UPMC HP providers and UPMC HP PHO/PO affiliates.
• Complete primary source verification information, including verification of applicant's license, board certification, hospital privileges, malpractice history, residencies, graduate medical education.
• Check for sanctions using appropriate verification sources.
• Obtain copies of Medical License, DEA certificate, and malpractice insurance face sheet.
• Prepare provider files for credentialing and recredentialing within 60-180 days of the provider's signature on the application according to UPMC HP policies and procedures.
• Perform data entry for fields that Credential department is responsible for on an ongoing basis to assure correct credentialing information in the directories.
• Review and update of information in the CACTUS database.
• Maintain the correct Availability status in Teams platform.
• File documents in the provider's file as they are received.
• Update credentials data in Health Plan databases according to department standards.
• Prepare the Exception packets for the monthly Credentials Committee meeting.
• Attend the Credentials Team meetings as scheduled.
• Outreach providers by phone, email, or fax in a timely manner.
• Capturing communication in the Notes section of the Verification Instance. Dated and initialed.