Provider Credentialing Data Specialist

Network Health; Menasha (WI); Hybrid; USD 45,000 - 55,000; Full time

Job summary

Network Health is seeking a Provider Integration Representative to support credentialing and provider informatics, ensuring accurate provider data across all lines of business. The role focuses on onboarding, credentialing, data integrity, and regulatory compliance (NCQA, CMS) in collaboration with internal teams.

The position requires residency in Wisconsin, the option to work from home with occasional travel to the Menasha corporate office; standard 8am-5pm, 40 hours weekly, 1.0 FTE.

Qualifications

• High school diploma required
• Associate degree in Business, Medical Staff Services, Insurance or related field preferred or equivalent experience
• One or more years of experience in managed care, provider data, credentialing, or provider operations
• Some knowledge of databases, word processing and spreadsheet applications (Microsoft 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 inquires 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
• Perform additional duties as assigned

Job description

Network Health is seeking a Provider Integration Representative to support credentialing and provider informatics, ensuring accurate provider data across all lines of business. The role focuses on onboarding, credentialing, data integrity, and regulatory compliance (NCQA, CMS) in collaboration with internal teams.

The position requires residency in Wisconsin, the option to work from home with occasional travel to the Menasha corporate office; standard 8am-5pm, 40 hours weekly, 1.0 FTE.