Impactful Credentialing & Compliance Specialist

UPMC; Washington (Washington County); Vor Ort; USD 45.000 - 65.000; Vollzeit

Zusammenfassung

UPMC is seeking a Credentialing Analyst to join a team delivering safe, high-quality patient care. You will verify and maintain provider credentials, conduct primary source verification, and collaborate with physicians, hospital leadership, and staff to ensure compliance with NCQA and state standards.

The role emphasizes data accuracy, timely credentialing, and confidential handling of sensitive information in a hospital setting.

Qualifikationen

• 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.
• Ability to manage multiple tasks and be flexible.

Aufgaben

• Maintain accurate provider credentialing and recredentialing records, ensuring compliance with organizational, state, federal, and NCQA standards.
• Verify and track provider credentials, licenses, insurance information, sanctions, and other required documentation.
• Perform primary source verification using databases and tools such as NPDB, Equifax, and federal sanction monitoring systems.
• Enter and maintain provider data in credentialing systems with a minimum 95% accuracy rate.
• Monitor expiring credentials and proactively follow up on licensure, references, sanctions, and other required renewals.
• Communicate directly with providers, medical staff, and internal departments to facilitate timely credentialing and issue resolution.
• Review, document, and escalate provider-specific concerns, complaints, and credentialing risks to appropriate leadership when necessary.
• Prioritize and manage credentialing workloads to ensure timely completion of applications, reappointments, and compliance requirements.
• Coordinate site visits, credentialing reviews, and checklist completion while maintaining strict confidentiality throughout the process.
• Provide cross-functional support to the Credentialing team, including backup coverage, spreadsheet maintenance, reporting, and collaboration with contracting and network management teams.

Kenntnisse

Communication skills

Organizational skills

Attention to detail

Data gathering/manipulation

Computer proficiency

Ausbildung

High school diploma or equivalent

Tools

NPDB

Equifax

Jobbeschreibung

UPMC is seeking a Credentialing Analyst to join a team delivering safe, high-quality patient care. You will verify and maintain provider credentials, conduct primary source verification, and collaborate with physicians, hospital leadership, and staff to ensure compliance with NCQA and state standards.

The role emphasizes data accuracy, timely credentialing, and confidential handling of sensitive information in a hospital setting.