Contract Specialist III (Hybrid)

UPMC•Pittsburgh, PA

2d•Hybrid

About The Position

UPMC Community Care Behavioral Health is hiring a full-time Contract Specialist III. This role will work in a hybrid structure, reporting to the office a few days per week. Occasional travel may also be required at times. 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.

Requirements

Bachelor's degree and 5 years relevant experience or 9 years of equivalent work experience required.
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.
Computer Skills with proficiency in Microsoft Office including: Internet Explorer, Excel, Word, Powerpoint, Visio and Access Software packages.

Nice To Haves

Preference will be given to those with a Bachelors degree.
Behavioral health experience is strongly preferred.
Prior contracting and/or provider networking experience is a bonus.
Prior experience in health insurance is a bonus.
General knowledge of managed care functions and management techniques preferred.

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.