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

THIS IS A NON-CIVIL SERVICE POSITION

Salary Range:

$43,901.00 - $69,639.00 Annually

Hiring Salary Range:

$43,901.00

Get to Know Us

Welcome to the City of Baltimore! Experience the reward of a fulfilling career and enjoy the added element of excitement in a vibrant, diverse atmosphere. The City of Baltimore offers limitless opportunities to help drive social impact, both on the job and in the community, while serving its citizens. Join us in making Baltimore a great place to live and work. In the City of Baltimore, we hire great people and provide them with the skills and opportunities to grow toward their career aspirations. If you are looking for a career change or are interested in learning more, explore our opportunities and benefits programs. We are excited to have you as a part of the City of Baltimore Team! The city offers medical, prescription drug, dental, vision, optional life, AD&D, and FSA plans. This office also supplies wellness programs, support groups, and workshops. You can learn about our benefits here: https://humanresources.baltimorecity.gov/hr-divisions/benefits

Joo Summary

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.

Essential Functions

• 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.

Minimum Qualifications

Education: High School Diploma or General Education Degree (GED)

AND

Experience: Have two (2) or more years of related work experience. 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.

OR

Equivalency Notes: Have an equivalent combination of education and experience.

Licenses, Registrations, and Certificates: Certified Provider Credentialing Specialist (CPCS) Certification – preferred (or CPCS certified within 12 months of employment). Previous experience with physician billing systems preferred

Knowledge, Skills, and Abilities

• 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.

Additional Information

Background Check

Eligible candidates under final consideration for appointment to positions identified as positions of trust will be required to complete authorization for a Criminal Background Check and/or Fingerprint screening, and must be successfully completed.

Probation

All persons, including current City employees, selected for this position must complete a 6-month mandatory probation.

Baltimore City Government is an Equal Employment Opportunity Employer, and we are committed to a workplace that values diversity, equity, and inclusion.  The City of Baltimore prohibits discrimination on the basis of race, color, religion, age, sex, ancestry, creed, national origin, disability status, genetics, marital status, military service, sexual orientation, gender identity/expression, or any other characteristic protected by federal, state, or local laws.  Applicants requiring accommodation during the hiring process should contact the Department of Human Resources directly. Requests for accommodation should not be attached to the application.

BALTIMORE CITY IS AN EQUAL OPPORTUNITY EMPLOYER