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UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

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Contract Specialist III

  • Job ID: 634079176
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Network Management
  • Location: 339 Sixth Avenue, Pittsburgh PA 15222
  • Union Position: No
  • Salary Range: $22.56 to $38.96 / hour

Description

UPMC is hiring a full-time Contract Specialist III to support the Network Management department. This will be a Monday through Friday daylight role and will be based out of Pittsburgh, PA. This position will be a hybrid role in PA, with some remote/work-from-home privileges and some travel to the office for meetings, trainings, department needs, etc.

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. The Contract Specialist maintains the contract files for all provider types. The Contract Specialist III will also provide full training for new staff.


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.

Qualifications

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


Licensure, Certifications, and Clearances:



UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct