Remote Provider Credentialing Specialist I

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

Job summary

CareFirst BlueCross BlueShield seeks a Credentialing Specialist to verify credentials and manage provider data for network participation in Baltimore. You will maintain the provider file, support recredentialing, and ensure compliance with regulatory standards.

The role requires attention to detail, strong communication, and proficiency with data systems. Qualified candidates typically have 3 years of credentialing or related health insurance experience, a high school diploma or GED, and

Qualifications

• 3 years physician credentialing or health insurance/managed care operations experience in a customer service, claims, billing and enrollment, or call center environment.
• Proficiency in Excel and Pivot tables.
• Understanding of credentialing processes and regulatory requirements.

Responsibilities

• Analyzes credentialing applications for primary source verification for network participation.
• Responds to inquiries regarding provider participation eligibility and credentialing status.
• Maintains provider files and related data systems with updates during credentialing and recredentialing.
• Identifies and resolves provider file issues and ensures data accuracy across systems.
• Prepares written responses to obtain incomplete or missing information.

Skills

Excel

Pivot tables

Verbal communication

Interpersonal skills

Medical terminology

Education

High school diploma or GED

Bachelor's degree in Business or Healthcare Administration

Tools

PICS inventory system

Job description

CareFirst BlueCross BlueShield seeks a Credentialing Specialist to verify credentials and manage provider data for network participation in Baltimore. You will maintain the provider file, support recredentialing, and ensure compliance with regulatory standards.

The role requires attention to detail, strong communication, and proficiency with data systems. Qualified candidates typically have 3 years of credentialing or related health insurance experience, a high school diploma or GED, and