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Position: Credentialing Provider
Location: Baltimore MD # Hybrid position
Contract to Hire
Job Description:
This role will credential practitioners for network participation with CareFirst BlueCross BlueShield and accurately maintain all provider data within the enterprisewide Provider file to supply the organization with provider data while ensuring compliance with regulatory accreditation legal and company requirements and standards. Proficient in Excel Credentialing Knowledge Customer Service skills Written Communication skills. Qualifications:
Education Level: High School Diploma Preferred (Bachelors Degree in Business Healthcare Administration or related field) 3 years physician credentialing experience or health insurance/managed care operations experience in a customer service claims billing and enrollment or call center environment. Must be proficient in the use of Excel spreadsheets and an understanding of Pivot tables. Proficient Excellent verbal and written communication and interpersonal skills. Ability to develop and maintain effective relationships with peers physicians and medical staff to create confidence respect and dependability. Proficient Knowledge of medical terminology Proficient Demonstrated proficiency utilizing reference materials and ability to follow Standard Operating procedures to reduce risk and ensure provider data accuracy and overall quality. Proficient Ability to understand jurisdictional requirements and the legal ramifications of the credentialing and provider file maintenance processes and interpret reasoning for performing verification and/or appropriate actions. Proficient Licenses/Certifications: Certified Provider Credentialing Specialist (CPCS) Pref
ESSENTIAL FUNCTIONS:
40% Analyzes credentialing applications to perform the primary source verification of the appropriate credentials in order for a practitioner to participate in the CareFirst networks. Once verified accepted and approved determines the appropriate networks for participation and obtains the appropriate executed contracts to effectuate the professional relationship and structures the provider group accordingly. 30% Responds to external and internal inquiries regarding provider participation eligibility and criteria participation status credentialing contractual status and provider file updates. Direct focus on the provider experience providing timely resolution dependable followup and proactive measures to ensure successful credentialing is achieved. Professional etiquette communications and sound decision making is required. 15% Maintains the provider file the Provider Information Control (PICS) inventory workflow system and electronic provider files with updated provider information during processes such as credentialing recredentialing demographic updates terminations and all other provider file maintenance activities. 10% Responsible for identifying analyzing and resolving immediate and existing provider file issues. Processes provider file inputs in accordance with applicable state laws and departmental guidelines. Verification of provider data and system release entered into the provider file database ensuring a successful integration with the other corporate systems. 5% Prepares written responses to obtain incomplete or missing information and or communicates effectively telephonically. Thanks & Regards
LAXMAN
KMM Technologies Inc.
CMMI Level 2 ISO 9001 ISO 20000 ISO 27000 Certified
WOSB SBA 8(A) MDOT MBE & NMSDC MBE
Tel: (240)Email:
