Credentialing specialist

About Wilmington Health

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina.

Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system.

In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients.

Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.

Purpose :

The Credentialing Assistant is responsible for supporting the Credentialing Specialist in all aspects of the credentialing, recredentialing and privileging process at Wilmington Health.

Essential Duties and Responsibilities

• Responsible for routine, standard communications and data-gathering activities associated with the credentialing and payer enrollment process, based on Team Protocols
• Responsible for maintaining up-to-date files on Wilmington Health Providers
• Responsible for organizing and maintaining documents and other items, digital or hardcopy, in the Provider’s file
• Responsible for maintaining credentialing software, i.e., building forms, queries, and reports, keeping abreast of version updates, etc.
• Responsible for publishing credentialing status reports and other communications to Wilmington Health Leadership in a timely and accurate manner
• Responsible for other administrative functions within the Credentialing Team

Other- Compliance, HIPAA and Security

• Employees acknowledge that compliance with Wilmington Health’s HIPAA, Security and Compliance Plan policies and procedures as well as all other Wilmington Health policies and procedures is a condition of employment and that any violation will result in sanctions up to and including termination based on the type and severity of the violation.
• Maintains confidentiality of provider and clinical personnel information.
• Extensive and frequent verbal and written communications with Clinicians, Medical Staff Offices, state licensing boards, professional references and internal company staff, requiring professionalism and tact, to obtain or provide all needed information quickly in order to expedite the credentialing of providers.
• Provides excellent customer service in accordance with Wilmington Health’s customer service standards to all internal and external parties.
• Achieves compliance with Credentialing Department metrics and performance standards by adhering to the Credentialing process and documenting accurately in company database(s).

Accurately maintains systems database(s) to track, follow-up and disseminate status of credentialing, hospital privilege and payer enrollment to other departments in a timely manner.

Attend and participate in required meetings; participating in developing and implementing company-wide goals; participates in problem-solving and decision making;

positively supports and adheres to management decisions, being flexible and adaptable to change, establishing trust and respect for other team members and completing training as required.

Communicates issues to management in a timely and accurate manner

Other Duties

Responsible for other duties as assigned

Minimum Qualifications

• A high school diploma or equivalent
• A minimum of 2 years’ experience in healthcare credentialing and / or payer enrollment
• Previous experience with credentialing software or other type of database
• Ability to use independent judgment to manage and impart confidential information; works independently, is self-directed and effective in a team, high-paced environment
• Ability to organize, prioritize, coordinate and follow thru on multiple activities and tasks in a timely manner
• Excellent customer service and organizational skills; excellent file management skills
• The ability to handle high volumes of files under tight deadlines and set priorities
• Strong teamwork orientation regarding resolution of issues
• Demonstrated proficiency of Excel, Word, and Outlook
• Excellent verbal and written communication skills are essential. Able to communicate and present information to a wide variety of parties effectively
• A high level of accountability

Wilmington Health is an Equal Opportunity Employer committed to providing equal opportunities to all applicants and employees.

We are committed to treating everyone equally and with respect regardless of race, age, sex, religion, national origin, citizenship, marital status, veteran’s status, sexual preference, disability, genetic information or any other class protected under state or federal law.

ADA Physical Demands

Rarely (Less than .5 hrs / day) Occasionally (0.6 2.5 hrs / day) Frequently (2.6 5.5 hrs / day) Continuously (5.6 8.0 hrs / day)

Physical Demand

Required?

Frequency

Standing

Frequently

Sitting

Continuously

Walking

Frequently

Kneeling / Crouching

Rarely

Lifting

Rarely

Credentialing Assistant Competencies

General

• Customer Service
• Professionalism / Integrity / Responsibility
• Teamwork / Process Focus
• Dependability / Punctuality
• Interpersonal Relationships / Communication
• Judgment / Decision Making / Problem Solving
• Quality / Quantity
• Initiative
• Safety / Housekeeping
• Organizational Skills / Time Management

Last updated : 2024-03-27