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Credentialing Clerk - Health Plan

  • Job ID: 166786286
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Quality Improvement
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $15.42 to $24.25 / hour

Description

UPMC Health Plan has an exciting opportunity for a Credentialing Clerk in its Quality Improvement department, located in downtown Pittsburgh at the U.S. Steel Tower.


The Credentialing Clerk supports the Credentials Department in administrative and clerical duties with daily coordination of initial and re-credentialing applications, provider mailings, and provider contacts for credentialing information requests.

 

Do you have prior administrative experience and stellar organizational skills?  Apply today!

Responsibilities:

 

  • All initial and recredentialing applications received into the Credentials Department in the CACTUS Credentialing database.
  • Perform duties and responsibilities in accordance with the philosophy, standards, and policies and procedures of UPMC Health System, including conveying courtesy, respect, enthusiasm and a positive attitude through all contacts with staff, health plan departments, providers, peers and visitors.
  • Research undeliverable/returned mail by checking CACTUS for additional addresses and/or calling provider office to confirm best mailing address. Fax application with updated address to appropriate contact. Update Credentialing addresses in CACTUS when necessary.
  • Perform three (3) follow-up calls on outstanding recredentialing applications to obtain application in a timely manner. If no response, send out a 60 days notice advising provider they will be termed. Assign follow-up to responsible HP Network department to request Network follow-up to obtain application or complete termination as appropriate.
  • Mail approval letters of initial providers. Make copies of all approval letters and add them to CACTUS Image Manager.
  • Send request for termination to responsible Network department with appropriate documents attached. Copy HP-Credentials department mailbox. Update CACTUS to reflect provider term.
  • Other clerical duties as assigned.
  • Scan approved provider files into P8 FileNet. Separate into appropriate document types, (decision and PSV) by provider name and number. Check that batch scanning has gone into P8 FileNet and all documents scanned are readable. Shred files after verifying scanned documents are correct.
  • Assist with preparation of recredentialing applications for monthly mailings, including 1st, 2nd and final letter packets and the packet instructions, along with and any supplemental information as needed.

 

  • All initial and recredentialing applications received into the Credentials Department in the CACTUS Credentialing database.
  • Perform duties and responsibilities in accordance with the philosophy, standards, and policies and procedures of UPMC Health System, including conveying courtesy, respect, enthusiasm and a positive attitude through all contacts with staff, health plan departments, providers, peers and visitors.
  • Research undeliverable/returned mail by checking CACTUS for additional addresses and/or calling provider office to confirm best mailing address. Fax application with updated address to appropriate contact. Update Credentialing addresses in CACTUS when necessary.
  • Perform three (3) follow-up calls on outstanding recredentialing applications to obtain application in a timely manner. If no response, send out a 60 days notice advising provider they will be termed. Assign follow-up to responsible HP Network department to request Network follow-up to obtain application or complete termination as appropriate.
  • Mail approval letters of initial providers. Make copies of all approval letters and add them to CACTUS Image Manager.
  • Send request for termination to responsible Network department with appropriate documents attached. Copy HP-Credentials department mailbox. Update CACTUS to reflect provider term.
  • Other clerical duties as assigned.
  • Scan approved provider files into P8 FileNet. Separate into appropriate document types, (decision and PSV) by provider name and number. Check that batch scanning has gone into P8 FileNet and all documents scanned are readable. Shred files after verifying scanned documents are correct.
  • Assist with preparation of recredentialing applications for monthly mailings, including 1st, 2nd and final letter packets and the packet instructions, along with and any supplemental information as needed.

 

  • All initial and recredentialing applications received into the Credentials Department in the CACTUS Credentialing database.
  • Perform duties and responsibilities in accordance with the philosophy, standards, and policies and procedures of UPMC Health System, including conveying courtesy, respect, enthusiasm and a positive attitude through all contacts with staff, health plan departments, providers, peers and visitors.
  • Research undeliverable/returned mail by checking CACTUS for additional addresses and/or calling provider office to confirm best mailing address. Fax application with updated address to appropriate contact. Update Credentialing addresses in CACTUS when necessary.
  • Perform three (3) follow-up calls on outstanding recredentialing applications to obtain application in a timely manner. If no response, send out a 60 days notice advising provider they will be termed. Assign follow-up to responsible HP Network department to request Network follow-up to obtain application or complete termination as appropriate.
  • Mail approval letters of initial providers. Make copies of all approval letters and add them to CACTUS Image Manager.
  • Send request for termination to responsible Network department with appropriate documents attached. Copy HP-Credentials department mailbox. Update CACTUS to reflect provider term.
  • Other clerical duties as assigned.
  • Scan approved provider files into P8 FileNet. Separate into appropriate document types, (decision and PSV) by provider name and number. Check that batch scanning has gone into P8 FileNet and all documents scanned are readable. Shred files after verifying scanned documents are correct.
  • Assist with preparation of recredentialing applications for monthly mailings, including 1st, 2nd and final letter packets and the packet instructions, along with and any supplemental information as needed.

 

  • All initial and recredentialing applications received into the Credentials Department in the CACTUS Credentialing database.
  • Perform duties and responsibilities in accordance with the philosophy, standards, and policies and procedures of UPMC Health System, including conveying courtesy, respect, enthusiasm and a positive attitude through all contacts with staff, health plan departments, providers, peers and visitors.
  • Research undeliverable/returned mail by checking CACTUS for additional addresses and/or calling provider office to confirm best mailing address. Fax application with updated address to appropriate contact. Update Credentialing addresses in CACTUS when necessary.
  • Perform three (3) follow-up calls on outstanding recredentialing applications to obtain application in a timely manner. If no response, send out a 60 days notice advising provider they will be termed. Assign follow-up to responsible HP Network department to request Network follow-up to obtain application or complete termination as appropriate.
  • Mail approval letters of initial providers. Make copies of all approval letters and add them to CACTUS Image Manager.
  • Send request for termination to responsible Network department with appropriate documents attached. Copy HP-Credentials department mailbox. Update CACTUS to reflect provider term.
  • Other clerical duties as assigned.
  • Scan approved provider files into P8 FileNet. Separate into appropriate document types, (decision and PSV) by provider name and number. Check that batch scanning has gone into P8 FileNet and all documents scanned are readable. Shred files after verifying scanned documents are correct.
  • Assist with preparation of recredentialing applications for monthly mailings, including 1st, 2nd and final letter packets and the packet instructions, along with and any supplemental information as needed.

 

  • All initial and recredentialing applications received into the Credentials Department in the CACTUS Credentialing database.
  • Perform duties and responsibilities in accordance with the philosophy, standards, and policies and procedures of UPMC Health System, including conveying courtesy, respect, enthusiasm and a positive attitude through all contacts with staff, health plan departments, providers, peers and visitors.
  • Research undeliverable/returned mail by checking CACTUS for additional addresses and/or calling provider office to confirm best mailing address. Fax application with updated address to appropriate contact. Update Credentialing addresses in CACTUS when necessary.
  • Perform three (3) follow-up calls on outstanding recredentialing applications to obtain application in a timely manner. If no response, send out a 60 days notice advising provider they will be termed. Assign follow-up to responsible HP Network department to request Network follow-up to obtain application or complete termination as appropriate.
  • Mail approval letters of initial providers. Make copies of all approval letters and add them to CACTUS Image Manager.
  • Send request for termination to responsible Network department with appropriate documents attached. Copy HP-Credentials department mailbox. Update CACTUS to reflect provider term.
  • Other clerical duties as assigned.
  • Scan approved provider files into P8 FileNet. Separate into appropriate document types, (decision and PSV) by provider name and number. Check that batch scanning has gone into P8 FileNet and all documents scanned are readable. Shred files after verifying scanned documents are correct.
  • Assist with preparation of recredentialing applications for monthly mailings, including 1st, 2nd and final letter packets and the packet instructions, along with and any supplemental information as needed.

 

Qualifications

  • High school graduate or equivalency required.
  • Minimum of 3 years of clerical experience.
  • Ensure customer service to both internal and external customers.
  • Computer efficiency in data base entry, Excel, Outlook, Word processing; Report generation essential.
  • High degree of organizational and communication skills.
  • Experience with phone etiquette to provider offices.
  • Demonstrated performance in deadline driven responsibilities.

    Licensure, Certifications, and Clearances:

    UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

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Our Values

No matter where we work or what we do, we’re driven by common values that guide our work and keep us accountable to one another. UPMC’s values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive, experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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