Provider Integration Representative

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.

• →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

• 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)

Network Health is an Equal Opportunity Employer