Remote Provider Credentialing Specialist (WI)

Network Health; Menasha (WI); On-site; USD 42,000 - 62,000; Full time

Job summary

Network Health is seeking a Credentialing Specialist to maintain provider data across systems and support credentialing, recredentialing, and ongoing monitoring needs. The role requires a high school diploma (associate degree preferred) and 1+ year in managed care or provider operations.

You will collaborate with internal teams and ensure NCQA, CMS and audit compliance. This Wisconsin-resident role offers home-office options with occasional travel to the Menasha corporate office to support

Qualifications

• High school diploma required; associate degree preferred.
• 1+ year experience in managed care, provider data, credentialing, or provider operations.
• Knowledge of databases, word processing and spreadsheet apps (Word, Excel, QuickBase, Echo).

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; respond to provider inquiries.
• Support NCQA, CMS, delegation and audit requirements.
• Respond to provider/interdepartmental inquiries via email, phone, etc.
• Aid in maintaining 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 security policies.

Skills

Credentialing experience

Provider data management

Data research

Education

High school diploma

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

Tools

Microsoft Word

Excel

QuickBase

Echo Credentialing Software

Job description

Network Health is seeking a Credentialing Specialist to maintain provider data across systems and support credentialing, recredentialing, and ongoing monitoring needs. The role requires a high school diploma (associate degree preferred) and 1+ year in managed care or provider operations.

You will collaborate with internal teams and ensure NCQA, CMS and audit compliance. This Wisconsin-resident role offers home-office options with occasional travel to the Menasha corporate office to support