Provider Integration Representative

Network Health WI; Menasha (WI); Hybrid; USD 52,000 - 68,000; Full time

Job summary

Network Health WI is seeking a Provider Integration Representative to support credentialing and provider informatics. You will help maintain provider data, onboarding, credentialing, and regulatory compliance across lines of business, ensuring NCQA and CMS standards are met.

The role requires Wisconsin residency, occasional travel to Menasha, 40 hours/week, 8am-5pm, and collaboration across departments to resolve data discrepancies and support audits.

Qualifications

• One or more years of experience in managed care, provider data, credentialing, or provider operations.
• High school diploma required; associate degree preferred in related field.
• Familiarity with databases and MS Office (Word, Excel) and credentialing software.

Responsibilities

• Maintain accurate provider demographic, contract and credentialing data across systems.
• Coordinate credentialing, recredentialing and ongoing monitoring needs.
• Research provider data discrepancies and respond to inquiries.
• Support NCQA, CMS, delegation and audit requirements.
• Identify and implement process improvements and automation opportunities.

Skills

Credentialing

Data management

Regulatory compliance

Communication

Education

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

Tools

Echo Credentialing Software

QuickBase

Excel

Word

Job description

The Provider Integration Representative will support personnel for Credentialing and Provider Informatics. This role is responsible for aiding provider data management, provider credentialing needs, and maintenance of accurate provider information across all lines of business. This role supports provider onboarding, credentialing, recredentialing, provider data integrity, regulatory compliance, and provider inquiries while ensuring compliance with NCQA, CMS, and organizational standards.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference.

Job 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 Requirements

• 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)

Network Health is an Equal Opportunity Employer