Provider Relations Representative

Upper Peninsula Health Plan•Marquette, MI

3d•Onsite

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 position fosters positive relationships through education, communication, outreach, and engagement, and supports network adequacy, accessibility, regulatory compliance, provider engagement, and access to care. The representative liaises with provider offices, helps them navigate organizational processes and resources, responds to provider concerns, and coordinates support with internal stakeholders and commercial network partners. The role also supports provider onboarding, communications, meetings, educational activities, outreach and site visits, provider data maintenance, contracting and credentialing processes, and regulatory reporting.

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 Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and confidentiality requirements.
Serve as a liaison between UPHP and participating provider offices, promoting positive relationships and effective communication; provide general assistance 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 work with internal and external stakeholders toward timely resolution and positive provider experiences.
Assist with provider onboarding and orientation, including informing providers about resources, educational materials, and organizational contacts.
Develop, coordinate, and distribute provider communications, including newsletters, announcements, educational materials, and other provider-facing communications.
Assist with planning, coordinating, and implementing provider meetings, educational webinars, in-services, and outreach initiatives.
Coordinate and conduct provider office outreach and site visits; maintain related documentation and execute, report, and maintain files for site visit surveys.
Liaise between provider offices and commercial companies that use the UPMC network; answer provider questions and work with companies to investigate and resolve provider-file discrepancies.
Coordinate provider information updates and advocate for providers by arranging systems-related support with commercial network partners.
Support accurate network provider data, enter provider and group contract information into the credentialing system, and work with configuration staff to ensure accurate provider data is loaded into the claims processing system.
Support other departments by verifying provider data, resolving issues 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 concerning contracting, network adequacy and access, provider directory data, and provider network policies.
Help ensure compliance with state, federal, and accrediting-agency network adequacy standards; augment or modify the provider network as needed, including to meet CMS standards.
Perform other related duties as assigned or requested.