Join Our Team as a Credentialing Analyst! Are you detail-oriented and passionate about ensuring healthcare excellence? Our hospital is seeking a dedicated Credentialing Analyst to join our team. In this role, you will play a crucial part in maintaining the highest standards of patient care by verifying and managing the credentials of our medical staff.

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.

• Provide back up for other Credentialing Analysts and to the Credentialing Team as assigned by the Credentialing Supervisor.

• Utilize 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 Medical Director 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.

• 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 & attention to detail.

• Ability to manage multiple task and be flexible to the daily needs of the organization.

• Computer competence.

Licensure, Certifications, and Clearances:

• Act 31 Child Abuse Reporting

• Act 33

• Act 34

• Act 73 FBI Clearance

UPMC is an Equal Opportunity Employer/Disability/Veteran