Provider Relations Representative

Upper Peninsula Health Plan • Marquette, MI

4d

About The Position

The Provider Relations Representative serves as a provider-facing resource for practitioners, providers, facilities, and provider offices participating in the Upper Peninsula Managed Care (UPMC) network. The role fosters positive relationships through education, communication, outreach, and engagement, and supports network adequacy, accessibility, regulatory compliance, provider engagement, and access to care.

The representative acts as a liaison between Upper Peninsula Health Plan (UPHP), participating provider offices, commercial companies using the UPMC network, and internal stakeholders. The position assists providers with UPHP processes, resources, programs, policies, and operational questions; supports provider onboarding and communications; and coordinates provider outreach, meetings, educational events, and site visits. It also supports accurate provider data and contracting information, network adequacy and access reporting, and compliance with applicable state, federal, and accrediting standards. The role follows organizational policies, procedures, safety standards, and requirements for protecting confidential information.

Requirements

• Associate degree in business, office information services, health information processing, computer information systems, or a related field.
• One to two years of experience in health-care operations, provider relations, or customer service.
• Working knowledge of Microsoft Office, including Word, Excel, and PowerPoint.
• Excellent interpersonal and oral and written communication skills.
• Excellent organizational and prioritization abilities, with attention to detail.

Nice To Haves

• Bachelor’s degree in communications, public relations, business administration, or a related field.
• Three to four years of customer relations experience in a health-care setting and/or a business background in health care.
• Prior contracting experience.

Responsibilities

• Follow UPHP policies and procedures, objectives, safety standards, and confidentiality requirements.
• Serve as a liaison between UPHP and participating provider offices, supporting positive relationships and effective communication through phone, email, mail, fax, or other channels.
• Help provider offices navigate UPHP processes and identify appropriate departments or resources; educate providers and office staff about resources, programs, self-service tools, policies, and procedures.
• Respond to provider relationship concerns and collaborate with internal and external stakeholders to support timely resolution and positive provider experiences.
• Assist with provider onboarding and orientation, including sharing resources, educational materials, and key organizational contacts.
• Develop, coordinate, and distribute provider communications, including newsletters, announcements, educational materials, and other provider-facing content.
• Plan, coordinate, and implement provider engagement activities, including provider meetings, educational webinars, in-services, and outreach initiatives.
• Coordinate and conduct provider office outreach and site visits; maintain documentation and execute, report, and maintain files for site visit surveys.
• Liaise between provider offices and commercial companies that use the UPMC network; respond to provider questions and work with those companies to investigate and resolve discrepancies in provider file information.
• Coordinate provider information updates and systems-related support with commercial network partners on providers’ behalf.
• Support provider data accuracy and enter provider and group contract information into the credentialing system; work with configuration staff to ensure accurate provider data is loaded into the claims processing system.
• Support other departments by verifying provider data, solving problems with provider offices, assisting with and finalizing provider communications, and responding to provider-related access and availability concerns and potential leads.
• Assist with MDHHS compliance reporting related to contracting, network adequacy and access, provider directory data, and provider network policies.
• Help ensure compliance with state, federal, and accrediting agencies’ network adequacy standards; augment and modify the provider network as needed, including to meet CMS standards.
• Perform other related duties as assigned or requested.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree