UPMC · 1 week ago
Contract Specialist III (Hybrid)
Pittsburgh, PA
Contract
Hybrid
Senior Level
5+ years expUPMC Community Care Behavioral Health is hiring a full-time Contract Specialist III. This role is responsible for facilitating the contracting process with providers and maintaining contract files while providing training for new staff.
BiotechnologyHealth CareHospitalMedical
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
Qualification
Required
Bachelor's degree and 5 years relevant experience or 9 years of equivalent work experience required
Excellent written and oral communication skills
Ability to work independently and to analyze complex situations accurately and in a timely manner
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
Preferred
Behavioral health experience is strongly preferred
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
Prior contracting and/or provider networking experience is a bonus
Prior experience in health insurance is a bonus
Company
UPMC
UPMC is one of the leading nonprofit health systems in the United States. A $10 billion integrated global health enterprise headquartered
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.46MKey Investors
Appalachian Regional Commission
2024-09-18Grant· $0.46M
Leadership Team
Leslie Davis
President and CEO
Frederick M. Hargett
Chief Financial Officer
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