Credentialing Professional

Become a part of our caring community If you're someone who loves details, organization, and making sure everything is just right, this could be the role for you! You will keep our provider network running smoothly. You will manage credentialing and recredentialing, maintain accurate provider records, support compliance and audits, and improve the way we work. Reporting to the Credentialing Supervisor, you will be a part of a dynamic team supporting the WI Medicaid Market. Main Responsibilities: Credentialing Operations: Performing initial and recredentialing for practitioners and organizational providers following established requirements. Compliance and Regulatory Oversight: Ensure credentialing activities meet NCQA, state Medicaid, DHS, CMS and internal policy requirements. Quality and Auditing: Maintain complete, accurate credentialing records and support audits and file reviews. Provider Data and Network Integrity: Maintain accurate provider records, monitor ongoing credentialing requirements, and coordinate provider and practitioner status changes with appropriate departments. Workflows: Monitor credentialing turnaround time, resolve discrepancies, and contribute to process improvement. Provider and Internal Department Coordination: Colloborate with network development, provider relations, contracting, compliance and external credentialing vendors to resolve discrepancies to ensure providers meet participation requirements. Use your skills to make an impact Required Qua