Provider Relations Representative

DATE: March 26 2026

POSITION: Provider Relations Representative

DEPARTMENT: Operations-Provider Relations

BASE RATE: $22.46 per hour with potential for additional compensation based on qualifications

POSITION SUMMARY:

This position handles provider relations with practitioners providers and facilities for the Upper Peninsula Managed Care (UPMC) network. This is accomplished through integration of activities with the UPMC claims customer service credentialing information systems and clinical services departments; provider offices; and the commercial companies that utilize the UPMC network.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Follows established Upper Peninsula Health Plan (UPHP) policies and procedures objectives safety standards and sensitivity to confidential information.

2. Assists practitioners and providers wishing to contract with UPHP and coordinates the contracting process and ensures all steps of the process are completed timely.

3. Provides general support to providers seeking assistance through phone email mail fax etc.

4. Acts as liaison for provider offices and commercial companies utilizing the UPMC network. This includes handling identified system claims issues reimbursement issues and provider file maintenance; answers inquiries from providers about commercial companies; and investigates and resolves discrepancies associated with provider file information with the commercial companies.

5. Assists commercial companies under network access agreements and new companies inquiring about network access and contracting agreements; responsible for facilitating provider information updates to commercial companies.

6. Responsible for the execution reporting and file maintenance of site visit surveys.

7. Supports processes to ensure network provider data is accurate and inputs provider and group contract information into the CACTUS credentialing system; works with configuration staff to ensure accurate provider data is loaded into the Claims Processing System.

8. Provides support to other departments through verification of provider data problem solving with provider offices assisting and finalizing provider communication documents and responding to access and availability provider related concerns and potential leads.

9. Assists in the planning and implementation of provider events including but not limited to provider in-service and educational webinars.

10. Assists in compliance reporting to Michigan Department of Health and Human Services (MDHHS) related to contracting network adequacy and access provider directory data and provider network related policies.

11. Assists in ensuring compliance with State Federal and accrediting agencies network adequacy standards. Augments and modifies the provider network as needed in order to comply with applicable network adequacy standards including those standards set forth by the Centers for Medicare and Medicaid Services (CMS).

12. Orients new and existing providers to the health plan; sends copies of provider material (i.e. provider newsletters formulary) to providers.

13. Demonstrates knowledge of National Committee for Quality Assurance (NCQA) standards for contracting site visits access and availability and supports NCQA submissions.

14. Maintains confidentiality of client data.

15. Performs other related duties as assigned or requested.

POSITION QUALIFICATIONS:

Education:

Minimum:

Preferred:

Experience:

Minimum:

Preferred:

Required Skills:

Physical Requirements

This job requires the ability to perform the essential functions contained in the description. These include but are not limited to the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements:

• Ability to access departmental files
• Ability to enter and access information from a computer
• Ability to access all areas of the UPHP offices
• Moderate physical effort (lift/carry up to 25 pounds)
• Occasionally lifts supplies/equipment
• Occasional reaching stooping bending kneeling crouching
• Prolonged periods of sitting
• Occasional prolonged standing
• Manual dexterity and mobility

Working Conditions

• Works in office conditions but occasional travel may be required
• Exposure to situations requiring exceptional interpersonal skills or periods of intense concentration
• Subject to many interruptions
• Occasionally subjected to irregular hours