Provider Credentialing & Data Specialist

Network Health; Town of Brookfield (WI); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Network Health in Wisconsin is seeking a Credentialing Specialist to maintain provider demographic, contract and credentialing data across systems. The role supports credentialing, recredentialing and ongoing monitoring, and works from a home office with occasional travel to the corporate office in Menasha.

Responsibilities include researching data discrepancies, responding to provider inquiries, supporting NCQA, CMS, delegation and audits, and safeguarding confidential information in line with

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 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
• Perform additional duties as assigned

Skills

Credentialing experience

Provider data management

Education

Associate degree in Business, Medical Staff Services, Insurance or related field

Tools

Echo Credentialing Software

QuickBase

Microsoft Word

Excel

Job description

Network Health in Wisconsin is seeking a Credentialing Specialist to maintain provider demographic, contract and credentialing data across systems. The role supports credentialing, recredentialing and ongoing monitoring, and works from a home office with occasional travel to the corporate office in Menasha.

Responsibilities include researching data discrepancies, responding to provider inquiries, supporting NCQA, CMS, delegation and audits, and safeguarding confidential information in line with