Credentialing Specialist

Upper Peninsula Health Plan (UPHP); Marquette (MI); On-site; USD 24,000 - 34,000; Full time

Job summary

Upper Peninsula Health Plan (UPHP) is seeking a Credentialing Specialist to perform confidential credentialing and related office duties in the Operations department. The role interfaces with UPHP staff, providers, and provider offices daily.

The position requires two years post-secondary education (or equivalent experience), strong MS Office skills, and excellent communication. Office-based work with occasional travel may be required.

Qualifications

• Excellent human relation and oral/written communication.
• Strong organizational and prioritization abilities with attention to detail.

Responsibilities

• Follows UPHP policies, procedures and confidentiality standards.
• Completes CVO duties: research, verifications, discrepancy checks, data compilation.
• Ensures provider credentialing compliance with NCQA, JC, MDHHS, CMS and DIFS.
• Processes applications for provider membership and reappointment.
• Maintains credentialing database accuracy and confidentiality; supports annual audit.
• Compiles credentialing status reports for clients and UPHP management.
• Maintains licenses, insurance, and board certifications for UPHP and clients.
• Reviews sanctions databases and monitors provider compliance.
• Responds promptly and professionally to provider inquiries.

Skills

Oral communication

Written communication

Organization

Keyboarding

Education

Two years post-secondary education or combination of education and experience

Associate or bachelor’s degree in business or health information

Tools

MS Office

Job description

DATE: September 30, 2026

POSITION: Credentialing Specialist

DEPARTMENT: Operations

RATE: $21.00 per hour, with potential for additional compensation based on qualifications.

POSITION SUMMARY:

The credentialing specialist performs confidential Upper Peninsula Health Plan (UPHP) credentialing and office duties and interfaces with UPHP staff, providers, and provider offices on a daily basis.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
• Completes Credentialing Verification Organization (CVO) duties which includes research, obtaining verifications, recognizing and investigating discrepancies in information, and compiling data for review.
• Follows established UPHP policies, procedures, and objectives to ensure provider credentialing is in compliance with all licensing standards and accrediting and regulating organizations, i.e., National Committee for Quality Assurance (NCQA), The Joint Commission (JC), the Michigan Department of Health and Human Services (MDHHS), Center for Medicare and Medicaid Services (CMS), and the Michigan Department of Insurance and Financial Services (DIFS).
• Processes applications for provider membership and reappointment in accordance with the UPHP credentialing policies.
• Maintains current information in the credentialing database; communicates via telephone, fax, and email with physicians and their key staff regarding currency of credentialing files.
• Maintains accuracy and confidentiality of UPHP credentialing database and participates in an annual audit of the database.
• Compiles credentialing status reports as necessary for CVO clients, internal UPHP departments, and senior management.
• Responsible for maintaining all applicable updates of licenses, insurance, and board certification of UPHP and CVO client providers.
• Reviews sanction databases and performs ongoing monitoring to ensure provider compliance.
• Responds quickly, courteously, and accurately to all provider status inquiries maintaining confidence and reliability to providers and clients.
• Performs other related duties as assigned or requested.

POSITION QUALIFICATIONS:

Education:

Minimum:

Two (2) years post-secondary education or combination of education and experience

Preferred:

Associate or bachelor’s degree in business, health information processing, health information

systems, or related field

Experience:

Minimum:

Two (2) years progressive office experience

Preferred:

One (1) year of credentialing experience

Required Skills:

Working knowledge of MS Office (Word, Excel, and PowerPoint)

Keyboarding proficiency

Excellent human relation and oral/written communication

Excellent organizational and prioritization abilities with attention to detail

The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.

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 enter and access information from a computer

Ability to access all areas of the UPHP offices

Occasionally lifts supplies/equipment

Prolonged periods of sitting

Manual dexterity

Working Conditions:

Works in office conditions, but occasional travel may be required

Subject to many interruptions

Occasionally subjected to irregular hours and bimonthly evening meeting