Contract Specialist III - Hybrid

UPMC•Pittsburgh, PA

9d•Hybrid

About The Position

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 follows a hybrid work model, with a few in-office days each week: Monday, Wednesday, and Thursday. The Contract Specialist III facilitates the process from identifying a provider needed in the network through contracting with that provider for services. The role reviews and approves changes to 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 specialist maintains contract files for all provider types and provides full training for new staff.

Requirements

Bachelor's degree and 5 years of relevant experience, or 9 years of equivalent work experience.
Thorough knowledge of NCQA standards and other relevant external quality standards.
Knowledge of state and federal contracting standards.
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.
Computer proficiency with Microsoft Office and related software, including Internet Explorer, Excel, Word, PowerPoint, Visio, and Access.
Act 34 clearance.

Nice To Haves

Preference will be given to candidates with a bachelor's degree.
Prior experience in 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

Respond to internal department inquiries about the provider network, including inquiries from Marketing and Government Programs.
Ensure provider contracts are fully executed by both parties and that copies are filed.
Coordinate adding new provider demographic information to UPMC Health Plan systems.
Review and approve specific inquiries related to credentialing and provider data maintenance.
Participate in projects as assigned by a Supervisor or Manager.
Support the Network and Vendor Relations Department by responding to internal and external customer inquiries.
Review provider applications, request missing information, and submit completed applications to credentialing.
Understand and train new staff on UPMC Health Plan products, policies, and procedures, including departmental policies.
Coordinate execution of electronic contracts with providers for contracting issues or contract changes.
Coordinate provider file changes with the provider information department.
Review and approve changes in contracted providers’ status that may affect their ability to remain in the provider network.
Maintain contract files for all provider types.