Contract Specialist III - Hybrid

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 70,000 - 95,000; Full time

Job summary

UPMC Community Care Behavioral Health seeks a full-time Contract Specialist III to streamline contract processes for providers added to the network. The role covers credentialing support, licensure changes, MA enrollment, and maintaining contract files in a centralized system.

Based in downtown Pittsburgh with a hybrid model (in-office Monday, Wednesday and Thursday), the position includes training new staff, coordinating electronic contracts, updating provider information, and supporting the

Responsibilities

• Respond to inquiries regarding provider network from other internal departments such as Marketing and Government Programs.
• Assure that provider contracts are fully executed by both parties and that contract copies are filed.
• Coordinate the addition of new provider demographic information into UPMC Health Plan systems.
• Review and approve specific inquiries related to credentialing and/or provider data maintenance.
• Participate in projects as assigned by Supervisor or Manager.
• Provide support to the Network and Vendor Relations Department by responding to inquiries from internal and external customers.
• Review provider applications, request missing information, and submit completed application to credentialing.
• Understand and train new staff on UPMC Health Plan products, policies and procedures including departmental policies.
• Coordinate the execution of electronic contracts to providers relating to contracting issues or contract changes.
• Coordinate provider file changes with the provider information department.

Job description

UPMC Community Care Behavioral Health is hiring a full-time Contract Specialist III. 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 III 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 III reviews and approves 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. The Contract Specialist III will provide full training for new staff.

Responsibilities:

• Respond to inquiries regarding provider network from other internal departments such as Marketing and Government Programs.
• Assure that provider contracts are fully executed by both parties and that contract copies are filed.
• Coordinate the addition of new provider demographic information into UPMC Health Plan systems.
• Review and approve specific inquiries related to credentialing and/or provider data maintenance.
• Participate in projects as assigned by Supervisor or Manager.
• Provide support to the Network and Vendor Relations Department by responding to inquiries from internal and external customers.
• Review provider applications, request missing information, and submit completed application to credentialing.
• Understand and train new staff on UPMC Health Plan products, policies and procedures including departmental policies.
• Coordinate the execution of electronic contracts to providers relating to contracting issues or contract changes.
• Coordinate provider file changes with the provider information department.