Provider Network Relations & Credentialing Specialist

CorVel Corporation; Waukesha (WI); On-site; USD 23,000 - 37,000; Full time

Job summary

CorVel Corporation in Wisconsin is seeking a Network Relations professional to support provider data integrity and network development. The role emphasizes excellent customer service, strong interpersonal skills, and market knowledge of the medical provider landscape.

You will verify provider documentation, assist with orientation, manage contracts, conduct data audits, and coordinate roster updates across national scope.

Qualifications

• Associate’s degree or two or more years of equivalent work experience.
• Customer service education/training within the insurance industry, managed care or related field.

Responsibilities

• Assist Developer with implementing medical providers, using written and verbal communication.
• Verify all provider signatures, contracts and documentation before submitting for internal processing.
• Review credentials of prospective providers to be considered for acceptance into network per national credentialing requirements and protocols.
• Provide orientation on managed care procedures and establish liaison(s) with all participating providers.
• Assist and communicate with provider orientation program in cooperation with Developer.
• Distribute and maintain provider manual and orientation materials per state guidelines.
• Receive and resolve all disputes involving provider contract and payment issues in accordance with contract Dispute Resolution Procedures.
• Provide assistance and respond to staff requests for information regarding the network, both locally and nationally.
• Oversee distribution of executed contracts and maintenance of database.
• Assist with network marketing, employer and payor relations and product development.
• Conduct and manage provider data audits that ensure data integrity for network and oversee all provider updates and changes with NDB.
• Coordinate and process provider roster updates at least annually or as otherwise required.
• Perform facility site surveys as needed per credentialing requirements or state guidelines.
• Identify specialties within network and generate a recruitment list for Developer.
• Additional duties as assigned.

Skills

Interpersonal skills

Written communication

Verbal communication

Complex problem solving

Adaptability

Organizational skills

Attention to detail

Education

Associate’s degree or two+ years of equivalent work experience

Customer service education/training in insurance/managed care

Tools

Microsoft Office

Job description

CorVel Corporation in Wisconsin is seeking a Network Relations professional to support provider data integrity and network development. The role emphasizes excellent customer service, strong interpersonal skills, and market knowledge of the medical provider landscape.

You will verify provider documentation, assist with orientation, manage contracts, conduct data audits, and coordinate roster updates across national scope.