Credentialing Specialist: Compliance & Provider Data

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

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.