Provider Contract Specialist II (Hybrid)

Pittsburgh Tomorrow; Pittsburgh (Allegheny County); Hybrid; USD 65,000 - 90,000; Full time

Job summary

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.

Qualifications

• 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.

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.

Skills

Communication skills

Independent work

Analytical thinking

Managed care knowledge

Education

Bachelor's degree

Job description

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.