Provider Credentialing & Network Enrollment Specialist

CareFirst BlueCross BlueShield; Baltimore (MD); On-site; USD 38,520 - 70,620; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

401(k) plan

Job summary

CareFirst BlueCross BlueShield is seeking a Credentialing Specialist to verify credentials for network participation and maintain provider data across the organization’s provider files.

Key duties include primary source verification, responding to inquiries, maintaining files, and ensuring compliance with regulatory standards. A High School Diploma or GED is required, CPCS preferred, with 3 years of credentialing or related experience expected.

Qualifications

• Education and licensure: High School Diploma or GED; CPCS preferred.
• Experience: 3 years physician credentialing or health insurance operations in customer service, claims, billing, enrollment, or call center.

Responsibilities

• Credentialing applications analyzed for primary source verification to determine network participation.
• Respond to inquiries about eligibility, status, and provider file updates, ensuring timely resolutions.
• Maintain provider file, PICS inventory, and electronic provider files during credentialing and updates.
• Identify and resolve provider file issues in compliance with state laws and guidelines.
• Prepare written responses for incomplete information requests.

Skills

Excel

Pivot tables

Verbal and written communication

Medical terminology

SOP adherence

Regulatory knowledge

Data accuracy

Education

High School Diploma or GED

Bachelor's degree in Business, Healthcare Administration or related field

Job description

CareFirst BlueCross BlueShield is seeking a Credentialing Specialist to verify credentials for network participation and maintain provider data across the organization’s provider files.

Key duties include primary source verification, responding to inquiries, maintaining files, and ensuring compliance with regulatory standards. A High School Diploma or GED is required, CPCS preferred, with 3 years of credentialing or related experience expected.