Remote Provider Credentialing & Data Specialist

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

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.