Contract Specialist II - Hybrid

UPMC • Pittsburgh, PA

9d • Hybrid

About The Position

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 follows a hybrid model, with a few in-office days each week—Monday, Wednesday, and Thursday.

The Contract Specialist II facilitates the process from identifying a provider needed in the network through contracting with that provider for services. The role reviews changes in contracted providers’ status that may affect their ability to remain in the network, including changes in licenses, certifications, Medical Assistance enrollment, and completion of precedential requirements. The position also maintains contract files for all provider types.

Requirements

• Bachelor’s degree and 3 years of relevant experience, or 7 years of equivalent work experience.
• Thorough knowledge of NCQA standards and other relevant external quality standards.
• Knowledge of state and federal standards for contracting.
• Knowledge of provider types.
• Knowledge and experience in contracting with providers for services.
• Excellent written and oral communication skills.
• Ability to work independently and analyze complex situations accurately and in a timely manner.
• Act 34 clearance.

Nice To Haves

• Preference will be given to candidates with a bachelor’s degree.
• Prior experience within health insurance or working with providers is strongly preferred.
• Prior contracting experience is a bonus.
• General knowledge of managed care functions and management techniques is preferred.

Responsibilities

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level