Job Description

Job Title: Credentialing Specialist
Job ID: 701757
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Children's Community Pediatrics
Department: BHC Billing Support
Location: 11279 Perry Highway, Wexford PA 15090

Description

Children's Community Pediatrics is hiring a full-time Credentialing Specialist at their Central Billing Office in Wexford. This position will be working the daylight shift, Monday through Friday.

Purpose:

Processes applications and performs primary source verification for applicants to the facilities and organizations of UPMC. Processes applications and performs primary source verification for reappointment and re-credentialing for practitioners who are members of the facilities and organizations of the UPMC. Maintains a current and accurate database of credentialing information.

Responsibilities:
  • Assists with database integrity and maintenance.
  • Completes files efficiently, according to policy and within the established standards and guidelines.
  • Maintains excellent communication (verbal, written and electronic) with all customers of the CVO including, but not limited to, the practitioners and the entity users.
  • Performs data entry and scans accurately and efficiently according to established policies, procedures and guidelines.
  • Performs primary source verification, records information received and provides follow up as necessary according to established policies and procedures.
  • Processes applications expeditiously and efficiently according to the established priorities and timeframes.

Qualifications

High school diploma or equivalent required. Associates or Bachelors degree preferred. Excellent data entry and computer software application skills required and must have a desire to maximize the use of technology to automate processes. Detail oriented person with excellent communication and interpersonal skills required. Prior credentialing experience preferred. Experience with both JCAHO and NCQA standards preferred.

Licensure, Certifications, and Clearances:
  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $14.95 to $22.97

Union Position: No

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