Provider Credentialing & Data Integrity Specialist

Network Health Administrative Services, LLC; Menasha, Town of Brookfield (WI, WI); Hybrid; USD 50,000 - 75,000; Full time

Job summary

Network Health Administrative Services, LLC is seeking a Provider Integration Representative to support credentialing, provider data management, and informatics across multiple plans. The role ensures data accuracy, onboarding, recredentialing, and regulatory compliance with NCQA and CMS standards.

The position requires Wisconsin residency, remote work availability, and occasional travel to the Menasha corporate office.

Qualifications

• High school diploma required.
• Associate degree preferred or equivalent experience.
• 1+ year of experience 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 needs.
• Research and resolve provider data discrepancies and respond to provider inquiries.
• Support NCQA, CMS, delegation and audit requirements.
• Responding to provider/interdepartmental inquiries via email, phone, etc.
• 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 organizational security policies.

Skills

Provider data management

Credentialing

Data integrity

Regulatory compliance

Provider inquiries

Education

High school diploma

Associate degree or equivalent

Tools

Echo Credentialing

Microsoft Word

Excel

QuickBase

Job description

Network Health Administrative Services, LLC is seeking a Provider Integration Representative to support credentialing, provider data management, and informatics across multiple plans. The role ensures data accuracy, onboarding, recredentialing, and regulatory compliance with NCQA and CMS standards.

The position requires Wisconsin residency, remote work availability, and occasional travel to the Menasha corporate office.