UPMC · 21 hours ago
Credentials Analyst HPL
Pittsburgh, PA
Full-time
Hybrid
Entry Level
2+ years expUPMC Health Plan is hiring a full time Credentials Analyst responsible for ensuring provider files comply with credentialing standards. The role involves coordinating credentialing activities, maintaining compliance, and supporting the UPMC HP Network staff.
BiotechnologyHealth CareHospitalMedical
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
Qualification
Required
Associate degree in business or healthcare (Experience in business, healthcare or customer service may be substituted for educational requirements)
Computer efficiency in database entry, Excel, word processing and report generating essential
Act 34
Preferred
Bachelor's degree
Two years' experience in credentialing
Experience in NCQA compliance in credentialing
One year of data entry or related experience
Company
UPMC
UPMC is one of the leading nonprofit health systems in the United States. A $10 billion integrated global health enterprise headquartered
10001+ employees
H1B Sponsorship
UPMC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (7)
2023 (4)
2022 (7)
2021 (7)
2020 (13)
Funding
Current Stage
Late StageTotal Funding
$0.46MKey Investors
Appalachian Regional Commission
2024-09-18Grant· $0.46M
Leadership Team
Leslie Davis
Chief Executive Officer
Frederick M. Hargett
Chief Financial Officer
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