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   Current UPMC employees must apply in HR Direct

Credentials Analyst

  • Job ID: 356053058
  • 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: $17.05 to $27.07 / hour

Description

UPMC Health Plan is hiring a full-time Credentials Analyst to support the Quality Improvement Department. 


The Credentials Analyst ensures that the provider files comply with UPMC Health Plan credentials standards prior to submission to the Credentials Committee.

Responsibilities:

  • Update credentials data in Health Plan databases according to department standards.
  • Complete primary source verification information, including: verification of applicant's license, board certification, hospital privileges, malpractice history, residencies, graduate medical education. Check for sanctions using appropriate verification sources. Obtain copies of DEA certificate, CME certificates and malpractice insurance face sheet.
  • File documents in the provider's file as they are received.
  • Attend the monthly Credentials Committee meetings as assigned.
  • Ensure customer service to both internal and external customers. Respond promptly, courteously and accurately to credentials questions from UPMC HP departments, UPMC HP providers and UPMC HP PHO/PO affiliates.
  • Prepare the packets for the monthly Credentials Committee meeting.
  • Forward a copy of the approval letters of providers in PHO's to the respective PHO Executive Directors and retain a copy in a secure area.
  • Review credentials/recredentials applications for completeness. Written and verbal communication with provider to obtain information necessary to complete application.
  • Prepare provider files for credentialing and recredentialing within 180 days of the provider's signature on the application according to UPMC HP policies and procedures.
  • Prepare and forward welcome letters to providers in a timely manner. File a copy of the welcome letter and provider profile in the provider's credentials file.

Qualifications

  • Associate degree in business or healthcare (Experience in business, healthcare or customer service may be substituted for educational requirements)
  • Bachelor's degree preferred.
  • Two years' experience in credentialing preferred.
  • Experience in NCQA compliance in credentialing preferred.
  • Computer efficiency in database entry, Excel, word processing and report generating essential.
  • One year of data entry or related experience preferred

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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