Credentialing Analyst

DescriptionUPMC Community Care Behavioral Health is seeking a full-time Credentialing Analyst to support the Credentialing Department within the UPMC Insurance Services Division!The Credentialing Analyst will work standard hours, Monday through Friday, with flexible arrangements for either a hybrid or remote work structure!The Credentialing Analyst will handle credentialing duties within Community Care, ensuring the accurate completion and maintenance of credentialing files. This role will take files for credentialing through the entire process, including interacting with external agencies for PSV and bringing problematic files to the attention of the Credentialing Supervisor. Additional responsibilities include, but are not limited to, communicating professionally with providers, completing accurate and clear contact notes, and working independently to meet metrics.The ideal candidate for this position will have exceptional data entry and computer skills, as well as strong attention to detail and a high level of professionalism. The ability to multitask and remain organized is vital to this role, as well. Previous credentialing experience is a plus!Responsibilities:Provide support to Data Management, including spreadsheet maintenance and 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 backup 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, including (but not limited to) NPDB queries, Act 33 & 34, claims histories, licensure, and 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.

QualificationsHigh 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 task and be flexible to the daily needs of the organization.

Computer competence.

Attention to detail.

Licensure, Certifications, and Clearances:Act 34

UPMC is an Equal Opportunity Employer/Disability/VeteranREQNUMBER: 266741249