Job Description

Job Title: Contract Specialist II
Job ID: 689819
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: HPLAN - Hospital Reimbursement
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
UPMC Health Plan is seeking a Contract Specialist II to support its Hospital Reimbursement Department!

 

The Contract Specialist II 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 II reviews 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.

 

Preferences are as follows: Microsoft application experience, Cactus experience, Sales Force experience helpful as well as the ability to mentor others and learn a variety of responsibilities.

This position is in US Steel; 7:30 to 4:00.


Responsibilities:

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

Qualifications

  • Bachelors degree and three (3) years relevant experience or seven (7) years of equivalent work experience required (contract experience preferred)
  • 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.

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $20.60 to $35.57

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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