Provider Credentialing Specialist I (Remote) - Dental

**Resp \& Qualifications** **PURPOSE:** This role will credential practitioners for network participation with CareFirst BlueCross BlueShield and accurately maintain all provider data within the enterprise\-wide Provider file to supply the organization with provider data, while ensuring compliance with regulatory, accreditation, legal and company requirements and standards. **ESSENTIAL FUNCTIONS:** * 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. * 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 follow\-up and proactive measures to ensure successful credentialing is achieved. Professional etiquette, communications and sound decision making is required. * 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. * 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. * Prepares written responses to obtain incomplete or missing information and or c