Provider Relations Representative

DEPARTMENT: Operations - Provider Operations ## RATE: $22.46 per hour, with potential for additional compensation based upon qualifications ## POSITION SUMMARY: This position serves as a provider-facing resource for practitioners, providers, facilities, and provider offices participating in the Upper Peninsula Managed Care (UPMC) network. The Provider Relations Representative fosters positive relationships through education, communication, outreach, and engagement activities. This position also supports network adequacy, accessibility, regulatory compliance, and initiatives strengthening provider engagement and improving access to care. ## ESSENTIAL DUTIES AND RESPONSIBILITIES: 1. Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information. 2. Serves as a liaison between UPHP and participating provider offices to promote positive provider relationships and effective communication. Provides general support to providers seeking assistance through phone, email, mail, fax, or other communication channels. 3. Assists provider offices in navigating UPHP processes and identifying the appropriate department or resource to address operational questions or concerns. Provides education to providers and provider office staff regarding UPHP resources, programs, self-service tools, policies, and procedures. 4. Responds to provider relationship concerns and collaborates with internal and external stakeholders to support timely resolution and positive provider experiences. 5. Assists with provider onboarding and orientation activities, ensuring providers are informed of available resources, educational materials, and key organizational contacts. 6. Develops, coordinates, and facilitates distribution of provider communications, including provider newsletters, announcements, educational materials, and other provider-facing communications. 7. Assists in the planning, coordination, and implementation of provider engagement activities, including provider meetings, educational webinars, in-services, and outreach initiatives. 8. Coordinates and conducts provider office outreach activities and site visits in accordance with departmental policies and procedures and maintains related documentation. Responsible for the execution, reporting, and file maintenance of site visit surveys. 9. Serves as the liaison between provider offices and commercial companies that use the UPMC network. Responds to provider questions about commercial companies and works with those companies to investigate and resolve discrepancies in provider file information. 10. Facilitates provider information updates and advocates for providers by coordinating systems-related support with commercial network partners. 11. Supports processes to ensure network provider data is accurate and inputs provider and group contract information into the credentialing system; works with configuration staff to ensure accurate provider data is loaded into the claims processing system. 12. 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. 13. Assists in compliance reporting to the Michigan Department of Health and Human Services (MDHHS) related to contracting, network adequacy and access, provider directory data, and provider network related policies. 14. Assists in ensuring compliance with sta