What are the responsibilities and job description for the Credentialing Analyst - UPMC Washington, WPHO position at UPMC?
Join Our Team as a Credentialing Analyst! Are you detail-oriented and passionate about ensuring healthcare excellence? Our hospital is seeking a dedicated Credentialing Analyst to join our team. In this role, you will play a crucial part in maintaining the highest standards of patient care by verifying and managing the credentials of our medical staff.
Responsibilities:- Provide support to Data Management including but not limited to: spreadsheet maintenance, license, degree and insurance product data query in contract and credentialing
- Demonstrate knowledge of state, federal, and NCQA regulations concerning credentialing.
- Provide back up for other Credentialing Analysts and to the Credentialing Team as assigned by the Credentialing Supervisor.
- Utilize 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 Medical Director or designee when provider specific information warrants, to include but not limited to NPDB queries, Act 33 & 34, claims histories, licensure, 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.
Salary : $23 - $29
