Handle credentialing /re-credentialing, obtaining provider privileging and state licensor responsibilities and duties across entire customer base of Infectious Disease Connect. Ensures the accurate completion and maintenance of credentialing and licensing records and files. Responsible for all aspects of credentialing and licensure including interacting with external agencies for PSV, state agencies and the providers themselves. Interacts with the delegated entities, physicians and others involved in the credentialing process.
•Initiate and maintain fluid and professional communication with individual providers being credentialed, tracking and following-up on items needed on a timely basis with a sense of urgency.
•Communicate with the CMO and staff regarding providers presenting problems with completing initial credentialing/re-credentialing.
•Identify problems/issues associated with the credentialing process and propose solutions, process improvements.
•Represent ID Connect in a professional, helpful, courteous manner with all providers, customers, states and regulators.
•Prioritize, delegate and coordinate work assignments related to credentialing processes to ensure timely completion with satisfactory results.
•Demonstrate knowledge of state, federal, and NCQA regulations concerning credentialing.
•Utilize Modio, Equifax, NPDB, and the federal cumulative sanction software for credentialing.
•Initiate consultation with the Chief Medical Officer or designee when provider specific information warrants, to include but not limited to NPDB queries, Act 33 & 34, claims histories, licensure, references.
•Track expired data for providers and follow-up appropriately including state licensure, professional references, NPDB, etc.
•Enter provider data into Modio and other data storage systems.
•Maintain confidentiality concerning queries through all credentialing processes.
•Coordinating with sales and senior management to proactively license ID Connect and its requisite providers in states that are new growth opportunities for the company.
•Maintain complete and accurate records regarding credentialing/re-credentialing for practitioners or facilities as assigned according to client(s) medical staff rules and regulations or bylaws; monitor and follow up as needed.
•Continuously monitor, develop and improve the credentialing process to ensure the highest degree of integrity and consistency.
•Coordinate and manage all activity related to the delegation and oversight of delegated functions within the realm of credentialing; including, but not limited to, reviewing delegates interim reports, conducting oversight reviews, education, and submitting recommendations and requests for action plans related to identified deficiencies.
-Bachelor's degree preferred.
-5-7 years experience in credentialing and licensing required.
-Previous supervisory experience preferred.
-Excellent written/verbal communication skills.
-High degree of organizational skills and problem solving skills required.
-Ability to gather and manipulate data accurately and consistently.
-Strong organizational skills.
-Ability to manage multiple task and be flexible to the daily needs of the organization.
-Attention to detail.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran