Provider Credentialing Specialist (Org Wide)

Description

Join our award winning culture as we serve members in your area!   

Under the direction of the Provider Relations Manager, the Provider Credentialing Specialist supports the development and maintenance of a high-quality, compliant, and member-centered provider network. This position manages credentialing and recredentialing activities, maintains provider records, supports provider onboarding and contracting processes, and ensures compliance with regulatory and organizational requirements. Through attention to detail, collaboration, and accountability, this role helps ensure network readiness and access to quality services that meet the diverse needs of Lakeland Care members.

Essential Competencies:

• Demonstrates ownership and accountability by managing credentialing and recredentialing activities in a timely, accurate, and compliant manner, proactively obtaining and tracking required provider documentation.
• Maintains accurate, complete, and confidential provider records, ensuring data integrity and compliance with organizational and regulatory requirements.
• Proactively monitors provider compliance requirements, credentials, and renewal timelines, partnering with providers to prevent lapses that may impact service delivery or network participation.
• Maintains confidentiality and appropriately safeguards provider information in accordance with organizational policies and applicable regulatory requirements.
• Uses sound judgment, critical thinking, and problem-solving skills to identify barriers, evaluate options, and develop practical solutions that support provider compliance and business needs.
• Maintains expertise in credentialing requirements, regulatory standards, and organizational policies while identifying opportunities to improve processes, efficiency, and provider experience.
• Serves as a knowledgeable resource on Lakeland Care contracting, credentialing requirements, Family Care program expectations, and applicable regulations.
• Utilizes credentialing systems, databases, and technology tools to analyze information, monitor compliance requirements, and support informed decision-making.
• Demonstrates attention to detail and a commitment to excellence by ensuring credentialing records are complete, accurate, and compliant with applicable standards.
• Actively contributes to continuous improvement initiatives by identifying process enhancements, sharing ideas, and supporting implementation of effective solutions.
• Supports organizational audits, reviews, and External Quality Review (EQR) activities by maintaining accurate records and responding timely to information requests.
• Demonstrates a commitment to professional growth by seeking feedback, developing knowledge, and applying best practices to improve outcomes.
• Demonstrates kindness and professionalism in all interactions by communicating respectfully, actively listening, and responding to provider and stakeholder needs in a timely, professional, and solution-focused manner.
• Demonstrates awareness of stakeholder needs and perspectives while working collaboratively to support credentialing and contracting activities.
• Promotes an inclusive environment by valuing diverse perspectives, experiences, and cultural differences and ensuring equitable treatment of providers and colleagues.
• Builds trust through consistent, transparent, and timely communication with contracted and prospective providers.
• Cultivates and maintains productive provider partnerships that support engagement, collaboration, and long-term network success.
• Follows through on commitments and actions to reinforce confidence and reliability in partnerships.
• Identifies opportunities to strengthen provider engagement and partnership through proactive communication and responsive support.
• Collaborates effectively across departments and with external providers to support organizational goals and positive provider experiences.
• Assists in the development, maintenance, and delivery of educational materials, resources, and presentations that promote provider understanding and compliance.
• Embraces organizational change with a positive and solution-focused mindset while supporting others through transitions.
• Demonstrates Lakeland Care's mission, vision, and values through daily actions and contributes to a culture of trust, inclusion, accountability, and continuous improvement.

Requirements

• Demonstrated ability to manage multiple priorities, maintain attention to detail, and perform work independently while contributing to team goals.
• Experience working with the population(s) served in the Family Care program preferred. 
• Experience in provider credentialing within a health insurance, managed care, or long-term care environment preferred. Knowledge of provider contracting, licensing requirements, regulatory systems, and provider network operations preferred.
• Exceptional organizational skills, accuracy, and precision in record-keeping activities are required.
• Demonstrated verbal and written communication skills, relationship-building abilities, customer service orientation, and the capacity to influence positive outcomes through collaboration and professionalism.
• Current driver’s license, acceptable driving record and proof of adequate insurance required. 
• High school diploma or GED required. Bachelor's degree in a human services, healthcare administration, business-related, or related field preferred. An equivalent combination of education, training, and experience that provides the required knowledge, skills, and abilities may be considered.

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Lakeland Care is a Wisconsin-based non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), Lakeland Care provides long-term care services and supports to eligible frail elders and individuals with physical and intellectual or developmental disabilities to achieve their daily and lifelong goals through Wisconsin’s Family Care program. Currently we serve in 22 counties and have 10 offices in the Central to North East region of Wisconsin.

Our Mission

Empowering individuals. Strengthening communities. Inspiring futures.

Our Vision

To create a world we all want to live in.

Our Core Values

Kindness – We believe kindness is always possible and that no compassionate act is ever wasted.

Inclusion – We believe that open hearts and open minds are the only path to a brighter future.

Trust – We believe that honesty is still in style and that promises still have power.

We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. We are an organization that participates in E-Verify.