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Provider Integration Representative
Network Health WI. Support personnel for Credentialing and Provider Informatics .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider credentialing, data management, and regulatory compliance, with a strong focus on maintaining accurate provider information and supporting onboarding processes. Proficient in utilizing credentialing software and office applications to enhance operational efficiency.
Highest-signal resume keywords
Provider CredentialingData ManagementRegulatory ComplianceMicrosoft ExcelQuickBase
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider Data ManagementCredentialingRecredentialingData IntegrityProcess DocumentationDatabase KnowledgeWord ProcessingSpreadsheet ApplicationsProvider OperationsResearch and Resolution
Soft Skills
CommunicationProblem-SolvingCollaborationAttention to DetailCustomer Service
Tools & Technologies
Microsoft WordMicrosoft ExcelQuickBaseEcho Credentialing Software
Industry Keywords
NCQACMSManaged CareProvider OnboardingAudit Requirements
About the role
Key responsibilities & impact- Support personnel for Credentialing and Provider Informatics
- Aid provider data management and provider credentialing needs
- Maintain accurate provider information across all lines of business
- Support provider onboarding, credentialing, recredentialing, provider data integrity, regulatory compliance, and provider inquiries
- 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 via email, phone, and other channels
- Support NCQA, CMS, delegation and audit requirements
- 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
Requirements
What you’ll need- 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
- Experience or knowledge of Microsoft Word, Excel, QuickBase, and Echo Credentialing Software
- Candidates must reside in the state of Wisconsin
- Reliable internet required for home office work
- Ability to travel occasionally to the corporate office in Menasha, including on the first day
- Ability to work 8am - 5pm Monday through Friday
Benefits
Comp & perks- Paid volunteer time in employees' local neighborhoods
- Home office work eligibility
- Reliable internet required for home office work