Provider Credentialing Support Coordinator I (Remote)

Resp & Qualifications

PURPOSE:
Responsible for the inventory intake for provider/practitioner enrollment, perform updates for non-participating providers, supports customer service phone team by responding to provider inquiries regarding credentialing processes and statuses to ensure high quality provider networks, promote a positive provider experience and support provider data accuracy. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business related activities.

ESSENTIAL FUNCTIONS:

• Reviews and researches the Portico, CAQH and Credentialing Inventory System to determine if provider is new or currently exist in the CareFirst network(s). Screens application and analyzes information retrieved from the CAQH and/or PORTICO systems to determine eligibility, completeness and the appropriate coding to create records in the Credentialing Inventory System. Creates new record in Portico and Credentialing Inventory System using the appropriate case types and when necessary assigns cases to the appropriate Credentialing Specialist.

• Respond to internal and external inquiries received via multiple email boxes for Undeliverable Mail, Medicare Advantage and priority email requests. Create cases for credentialing and add documents for demographic updates for requests received in phone inquiry email box. Update correct addresses in Portico for weekly nonpar FEP listings received due to bad addresses.

• Retrieve, research Portico and applicable Legacy systems to ensure nonpar data is appropriate. Add and update provider records in Portico and respond to claim routes from NASCO, FACETS, FEP and platform databases within required timeframes to ensure data accuracy within required timeframes.

• Respond to all inbound customer service calls and document questions and responses in the Credentialing Inventory System. Retrieve calls received in the departmental voice mailbox and respond to inquiries within required timeframe. Create cases and/or add documents for received Phone Inquiry email folder to ensure completion of credentialing cases and updates with required timeframe.

QUALIFICATIONS:

Education Level: High School Diploma.

Experience: 1 year General credentialing experience and 2 years General office experience preferably in a medical or insurance environment.

Preferred Qualifications:

• Medical or Insurance Environment.
• Experience in healthcare, customer service and/or credentialing (or any combination).

Knowledge, Skills and Abilities (KSAs)

• Strong interpersonal skills. Ability to work independently, as well as a member of a team.
• Strong customer service orientation and interpersonal skills.
• Strong computer skills, Excel, Word, Web based applications organization skills.
  
  

Department

Department:PROVIDER INFORMATION AND CREDE

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

#LI-NH2