Remote Provider Data & Credentialing Specialist

Milwaukee Succeeds; Menasha (WI); Hybrid; USD 45,000 - 65,000; Full time

Job summary

Network Health in Wisconsin is seeking a Provider Integration Representative to support Credentialing and Provider Informatics. You will aid provider data management, credentialing needs, and maintenance of accurate provider information across lines of business.

Responsibilities include onboarding, credentialing, recredentialing, data integrity, regulatory compliance, and handling provider inquiries while ensuring NCQA and CMS standards.

Qualifications

• 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)

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

Skills

Provider data management

Credentialing processes

Communications

Education

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

High school diploma

Tools

Microsoft Word

Microsoft Excel

QuickBase

Echo Credentialing Software

Job description

Network Health in Wisconsin is seeking a Provider Integration Representative to support Credentialing and Provider Informatics. You will aid provider data management, credentialing needs, and maintenance of accurate provider information across lines of business.

Responsibilities include onboarding, credentialing, recredentialing, data integrity, regulatory compliance, and handling provider inquiries while ensuring NCQA and CMS standards.