Remote Provider Credentialing & Data Specialist (WI)

Network Health Administrative Services, LLC; Menasha, Town of Brookfield (WI, WI); Hybrid; USD 42,000 - 60,000; Full time

Job summary

Network Health Administrative Services, LLC is seeking a Provider Integration Representative to support credentialing, data management, and provider informatics. The role ensures accurate provider information across lines of business, onboarding and recredentialing, and regulatory compliance with NCQA and CMS.

Based in Wisconsin, you will primarily work from home with occasional travel to the Menasha corporate office.

Qualifications

• High school diploma required.
• Associate degree preferred or equivalent experience.
• 1+ year of experience in managed care, provider data, credentialing, or provider operations.
• Familiar with databases, 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

Provider data management

Credentialing

Managed care

Education

Associate degree in related field

Tools

Echo Credentialing Software

QuickBase

Microsoft Word

Excel

Job description

Network Health Administrative Services, LLC is seeking a Provider Integration Representative to support credentialing, data management, and provider informatics. The role ensures accurate provider information across lines of business, onboarding and recredentialing, and regulatory compliance with NCQA and CMS.

Based in Wisconsin, you will primarily work from home with occasional travel to the Menasha corporate office.