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Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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Credentials Analyst

Description

UPMC Health Plan is hiring a full-time Credentials Analyst to support the National Network Management department. This position will work daylight hours, Monday through Friday. The team is based in downtown Pittsburgh's US Steel Tower, however, this position will work in a hybrid structure. 

The Credentials Analyst will ensure that the provider files comply with UPMC Health Plan (UPMC HP) credentials standards prior to submission to the Credentials Committee. They will assist in maintaining department compliance with all governing bodies and be responsible for coordinating the timely Credentialing activities that are necessary to support the credentialing and re-credentialing of UPMC HP direct contracted providers and to provide support to the UPMC HP Network staff. Additionally, they will assist with database maintenance and integrity.

Responsibilities:

 

  • Review credentials/recredentials applications for completeness. Written and verbal communication with provider to obtain information necessary to complete application.
  • 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.
  • 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 Medical License, DEA certificate, and malpractice insurance face sheet.
  • Prepare provider files for credentialing and recredentialing within 60-180 days of the provider's signature on the application according to UPMC HP policies and procedures.
  • Perform data entry for fields that Credential department is responsible for on an ongoing basis to assure correct credentialing information in the directories. Review and update of information in the CACTUS database.
  • Maintain the correct Availability status in Teams platform. File documents in the provider's file as they are received. Update credentials data in Health Plan databases according to department standards. Prepare the Exception packets for the monthly Credentials Committee meeting. Attend the Credentials Team meetings as scheduled.
  • Outreach providers by phone, email, or fax in a timely manner. Capturing communication in the Notes section of the Verification Instance. Dated and initialed.
  •  Performs in accordance with system-wide competencies/behaviors. 
  • Performs other duties as assigned. 

 

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.


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UPMC is an Equal Opportunity Employer/Disability/Veteran

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