Provider Integration Representative

Network Health WI • Menasha, WI

1d • Hybrid

About The Position

The Provider Integration Representative will support personnel for Credentialing and Provider Informatics. This role is responsible for aiding provider data management, provider credentialing needs, and maintenance of accurate provider information across all lines of business. This role supports provider onboarding, credentialing, recredentialing, provider data integrity, regulatory compliance, and provider inquiries while ensuring compliance with NCQA, CMS, and organizational standards.

Requirements

• High school diploma required
• 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)

Nice To Haves

• Associate degree in Business, Medical Staff Services, Insurance or related field preferred or equivalent experience

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

Benefits

• paid to volunteer in your local neighborhood

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED