Contract Specialist III - Hybrid

Life in Pittsburgh; Pittsburgh (Allegheny County); Hybrid; USD 70,000 - 90,000; Full time

Job summary

UPMC Community Care Behavioral Health is seeking a Contract Specialist III for a full-time, hybrid role in downtown Pittsburgh. This role entails managing provider contracts from identification through execution and ongoing credentialing support across the provider network.

The ideal candidate has a Bachelor's degree with 5 years of relevant experience (or 9 years of equivalent work), strong communication skills, and a solid background in health plan contracting and NCQA standards, with

Qualifications

• Bachelor's degree and 5 years relevant experience or 9 years of equivalent work experience required.
• Preference will be given to those with a Bachelor's degree.
• Prior experience in 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.
• Computer Skills with proficiency in Microsoft Office including: Internet Explorer, Excel, Word, Powerpoint, Visio and Access Software packages.

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.
• Train new staff on UPMC Health Plan products, policies and procedures.
• Coordinate the execution of electronic contracts to providers relating to contracting issues or contract changes.
• Coordinate provider file changes with the provider information department.

Skills

Contracting experience

Provider relations

Written and oral communication

Independent work

Managed care knowledge

Education

Bachelor's degree

Tools

MS Office Suite

Excel

Word

PowerPoint

Visio

Access

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.

• Bachelor's degree and 5 years relevant experience or 9 years of equivalent work experience required.
  • Preference will be given to those with a Bachelor's degree.
• Prior experience in 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.
• Computer Skills with proficiency in Microsoft Office including: Internet Explorer, Excel, Word, Powerpoint, Visio and Access Software packages.

Licensure, Certifications, and Clearances

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran