Lumen Solutions Group Inc. · 2 months ago
Provider Relations Representative
Baltimore, MD
Full-time
Hybrid
Mid Level
3+ years expLumen Solutions Group Inc. is seeking a Provider Relations Representative to serve as a key liaison between CareFirst and its provider network. This role focuses on supporting healthcare providers through proactive communication, issue resolution, and relationship management, ensuring they receive accurate assistance with claims and operational concerns.
Information Technology & Services
Responsibilities
Act as the primary point of contact for provider inquiries, ensuring timely and professional resolution
Manage and respond to 25–45 calls and emails per day related to provider questions, concerns, or escalations
Triage and resolve issues involving claims, provider setup, credentialing, and general service needs
Support internal departments in addressing provider concerns when no assigned representative is available
Collaborate with cross-functional teams to streamline issue resolution and enhance provider satisfaction
Maintain detailed documentation of all interactions and resolutions within CareFirst systems
Assist with small-scale project management activities tied to provider operations and performance initiatives
Contribute to the continuous improvement of provider service processes through feedback and trend analysis
Qualification
Required
3+ years of hands-on experience working with healthcare claims (submitting, filing, or resolving)
Strong understanding of Medicare and Medicaid billing and reimbursement
Experience in provider relations, provider services, or billing within a payer or provider environment
Proficiency in Microsoft Excel — must be able to filter, sort, and create pivot tables
Excellent communication skills (10/10 verbal and written) — ability to communicate clearly with providers and internal stakeholders
Ability to manage multiple priorities in a high-volume, fast-paced environment
Preferred
Experience using Facets, FEP Direct, GuidingCare, CareFirst Direct, or NASCO systems
Knowledge of CareFirst PPO Plans, Blue Choice HMO, Blue Card, Medicare Advantage, and Medicaid programs
Certified Professional Coder (CPC) or related credential
Prior experience with CareFirst systems or provider network operations
Company
Lumen Solutions Group Inc.
Lumen Solutions Inc., is a dynamic small and minority-owned, Disadvantaged Business Enterprise headquartered in Virginia, USA.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Charanjiv Gadh
Chief Executive Officer
Company data provided by crunchbase