Contract Specialist II - Hybrid

Life in Pittsburgh; Pittsburgh (Allegheny County); Hybrid; USD 65.000 - 90.000; Vollzeit

Zusammenfassung

UPMC Community Care Behavioral Health in Pittsburgh is seeking a full-time Contract Specialist II to manage contracting processes from provider identification to execution, with a focus on provider enrollment, credentialing, and file maintenance.

The role requires the ability to work in a hybrid environment with in-office days Monday, Wednesday, and Thursday, and to coordinate with internal departments and external providers. Prior health insurance or contracting experience is preferred.

Qualifikationen

• Bachelor's degree and 3 years relevant experience or 7 years of equivalent work experience required.
• Preference will be given to those with a Bachelor's degree.
• Prior experience within health insurance or working with providers strongly preferred.
• Prior contracting experience is a bonus.
• Thorough knowledge of NCQA standards and other relevant external quality standards.
• Knowledge of state and federal standards for contracting.
• Knowledge of Provider Types.
• Knowledge with experience in contracting with providers for services.
• Excellent written and oral communication skills.
• Ability to work independently and to analyze complex situations accurately and in a timely manner.
• General knowledge of managed care functions and management techniques preferred.

Aufgaben

• Coordinate the addition of new provider demographic information into UPMC Health Plan systems.
• Respond to inquiries regarding provider network from other internal departments such as Marketing and Government Programs.
• Assemble binders for Department of Health and DPW filings.
• Review provider applications, request missing information, and submit completed application to credentialing.
• Coordinate provider file changes with the provider information department.
• Custodian for all Network and Vendor Relations Contract Files.
• Assure that provider contracts are fully executed by both parties and that contract copies are filed.
• Provide support to the Network and Vendor Relations Department by responding to inquiries from internal and external customers.
• Coordinate mailing to providers relating to new contracting issues or contract changes.

Kenntnisse

Communication skills

Independent work

Analytical thinking

Managed care knowledge

Ausbildung

Bachelor's degree

Jobbeschreibung

UPMC Community Care Behavioral Health is hiring a full-time Contract Specialist II. The team is headquartered in downtown Pittsburgh at the U.S. Steel Tower. This position will work in a hybrid model, with a few in office days each week – Monday, Wednesday and Thursday.

The Contract Specialist II is responsible for facilitating a seamless process from the time a provider is identified as needed in the network to contracting with the provider for services. The Contract Specialist II reviews any alterations in the status of contracted providers that may impact on their ability to continue to be in the provider network including changes in license, certifications, Medical Assistance enrollment and completing precedential requirements. Maintains the contract files for all provider types.

Responsibilities:

• Coordinate the addition of new provider demographic information into UPMC Health Plan systems.
• Respond to inquiries regarding provider network from other internal departments such as Marketing and Government Programs.
• Assemble binders for Department of Health and DPW filings.
• Review provider applications, request missing information, and submit completed application to credentialing.
• Coordinate provider file changes with the provider information department.
• Custodian for all Network and Vendor Relations Contract Files.
• Assure that provider contracts are fully executed by both parties and that contract copies are filed.
• Provide support to the Network and Vendor Relations Department by responding to inquiries from internal and external customers.
• Coordinate mailing to providers relating to new contracting issues or contract changes.

• Bachelors degree and 3 years relevant experience or 7 years of equivalent work experience required.
  • Preference will be given to those with a Bachelor's degree.
• Prior experience within health insurance or working with providers strongly preferred.
• Prior contracting experience is a bonus.
• Thorough knowledge of NCQA standards and other relevant external quality standards.
• Knowledge of state and federal standards for contracting.
• Knowledge of Provider Types.
• Knowledge with experience in contracting with providers for services.
• Excellent written and oral communication skills.
• Ability to work independently and to analyze complex situations accurately and in a timely manner.
• General knowledge of managed care functions and management techniques preferred.

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran