Credentialing and Provider Enrollment Specialist, Grant Services Specialist III (NCS) - Baltimore City Health Department

Baltimore City•Baltimore, MD

About The Position

The Baltimore City Health Department is currently seeking a dynamic individual to serve as a Credentialing and Provider Enrollment Specialist. Under the supervision of the Director of Revenue Cycle Management (RCM), the Provider Credentialing & Enrollment Specialist III is responsible for managing all aspects of provider credentialing and enrollment across multiple platforms, including ePrep, CAQH, PECOS, and various payer portals. This position ensures the timely and accurate processing of new and existing provider enrollments, maintains compliance with payer and regulatory requirements, and supports RCM operations by resolving credentialing-related claim denials. The Specialist serves as the primary point of contact for credentialing activities, proactively communicating updates to the RCM team, cross-functional departments, and leadership. The role requires exceptional attention to detail, strong organizational and communication skills, and the ability to maintain strict confidentiality while managing sensitive provider data. The Specialist ensures the accuracy of the master provider roster and supports system data integrity by identifying and resolving credentialing-related errors within Epic and other systems.

Requirements

High School Diploma or General Education Degree (GED)
Have two (2) or more years of related work experience.
Excellent verbal and written communication skills including proven dispute resolution skills.
Thorough understanding of federal, state, and local equal employment opportunity laws and regulations.
Excellent organizational skills and attention to detail.
Strong analytical and problem-solving skills.
Proficient with Microsoft Office Suite or related software.

Nice To Haves

Bachelor’s degree – preferred.
In lieu of degree, four (4) or more years of experience in RCM, Provider Credentialing and Payer Enrollments will be accepted.
Certified Provider Credentialing Specialist (CPCS) Certification – preferred (or CPCS certified within 12 months of employment).
Previous experience with physician billing systems preferred

Responsibilities

Manage end-to-end credentialing and enrollment processes for all new and existing providers in ePrep, CAQH, PECOS, and various payer portals.
Maintain and update the master provider roster to ensure accurate provider information across all systems.
Track and monitor credentialing and re-credentialing deadlines to ensure continuous provider participation and compliance.
Research and resolve credentialing-related Epic Work Queue (WQ) errors and other payer enrollment discrepancies.
Prepare, review, and submit credentialing and enrollment applications and documentation in accordance with payer requirements and internal timelines.
Communicate proactively with providers, payers, and internal teams regarding credentialing status, updates, and delays.
Collaborate with the Revenue Cycle Management team to resolve claims denials related to provider credentialing or enrollment issues.
Ensure data accuracy within all credentialing databases and payer systems; perform regular audits to identify and correct inconsistencies.
Maintain strict confidentiality of all provider information and follow all HIPAA and organizational compliance policies.