Provider Credentialing & Data Integrity Specialist

Network Health Administrative Services, LLC; Menasha (WI); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Network Health Administrative Services, LLC is seeking a Provider Integration Representative to support credentialing, provider informatics, and data integrity across all lines of business. This role ensures data accuracy, onboarding, recredentialing, and regulatory compliance with NCQA and CMS standards.

The position requires Wisconsin residency, home-office eligibility with occasional travel to the Menasha corporate office. Typical hours are 40 per week, 8am–5pm, Monday through Friday.

Qualifications

• High school diploma required.
• Associate degree preferred or equivalent experience.
• 1+ years in managed care, provider data, credentialing, or provider operations.
• Some knowledge of databases, Word, Excel, QuickBase, and Echo Credentialing Software.

Responsibilities

• Maintain accurate provider demographic, contract and credentialing data across systems.
• Coordinate and aid in credentialing, recredentialing and ongoing monitoring.
• Research and resolve provider data discrepancies and respond to inquiries.
• Support NCQA, CMS, delegation and audit requirements.
• Respond to provider/interdepartmental inquiries via email or phone.
• Aid in maintain credentialing policies, desk references and process documentation.
• Partner with internal departments and provider offices to resolve issues.
• Identify and implement process improvements and automation opportunities.
• Protect confidential information and comply with security policies.
• Perform additional duties as assigned.

Skills

Provider data management

Credentialing

Regulatory compliance

Data integrity

Education

High school diploma

Associate degree preferred

Related field experience

Tools

Microsoft Word

Microsoft Excel

QuickBase

Echo Credentialing Software

Job description

Network Health Administrative Services, LLC is seeking a Provider Integration Representative to support credentialing, provider informatics, and data integrity across all lines of business. This role ensures data accuracy, onboarding, recredentialing, and regulatory compliance with NCQA and CMS standards.

The position requires Wisconsin residency, home-office eligibility with occasional travel to the Menasha corporate office. Typical hours are 40 per week, 8am–5pm, Monday through Friday.