Job Description

Job Title: Contract Specialist II
Job ID: 10552077
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Hospital Reimbursement
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC Health Plan has an exciting opportunity for a Contract Specialist II in its Hospital Reimbursement department, located in downtown Pittsburgh at the U.S. Steel Tower.

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. The Contract Specialist II also maintains the contract files for all provider types.

PREFERENCES: Attention to detail, Microsoft Excel, organizational skills, establish rapport with a diverse population, capable of meeting strict deadlines, time management.

Position has a possibility of work-from-home for one day a week after six months of good work performance. 

Responsibilities:

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

Qualifications

• Bachelors degree and 3 years relevant experience or 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/Disability/Veteran

Salary Range: $20.30 to $33.86 / hour

Union Position: No

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