Q&A: How to create an efficient provider credentialing process


The provider credentialing process can be daunting and trying to stay organized … well, it’s tough. If you aren’t deliberate about having a process in place, it can result in a lot of wasted time. Ultimately meaning your providers are waiting even longer to start seeing patients. 


That’s why we sat down with one of our credentialing specialists to get insight into how our team maintains an efficient process for credentialing providers, even during busy and hectic times.


Check out some tips and tricks that can get you on your way to having a more efficient physician credentialing process.


Q: What is the first thing you do Monday morning to get you ready for the week?

A: I use my credentialing software, which has a task management tool to help keep all of my weekly tasks and break it down by day. At the beginning of the week, I typically like to look for ways I can pace myself and make sure my days are as efficient as possible. After I look at my weekly planning chart, I sort through any emails I missed over the weekend.


Q: How do you stay organized with so many open tasks?


A: First and foremost, CredentialGenie’s credentialing software makes keeping track of tasks significantly easier. It has the ability to create and track all of my open tasks.

Beyond that, it really comes down to forcing myself to be organized and creating processes that will ensure I’m are staying on track.


It can definitely be overwhelming at times, which can make it easy for things to become unorganized. For me, I really like knowing where everything is so I have an easier time accessing information. For example, I keep my email communication organized by having individual folders for each medical group. This helps me when I need to find something quickly; I can go directly to the folder.


I also believe it’s vital to be familiar with the credentialing process and all the moving pieces. The more comfortable and knowledgeable you are, the easier it is to stay organized. Once you have familiarized yourself with the process, prioritizing tasks becomes much easier.


Q: How do you plan out your week when you are credentialing multiple physicians?


A: I find the best way for me to plan out my week is to assign certain providers to a specific day. For example, I plan to work on “Dr. ABC’s” profile every Wednesday while working “Dr. XYZ’s” profile on Fridays.


Keeping providers assigned to a specific day helps keep me organized. I am able to pre-plan for weeks in advance and figure out which follow-up tasks need to be prioritized and can better forecast when I believe a provider will be completely credentialed and enrolled. Further, I typically work on the same types of credentialing tasks around the same time every week.


Something else I learned when I first started my career in credentialing, is how important it was to be mindful of timezones. For smaller medical practices, this most likely won’t be an issue. But if your organization has facilities located throughout the country, this can be super helpful. I make sure I work on providers located in the east coast and central time zones in the morning and save the rest for after lunch.


Q: How do you prioritize your follow-up vs. new tasks that come in?


A: Unless I have scheduled a call with a representative at a specific time or a provider has specifically asked me to call right away, new tasks always get done first. We try to set a goal of getting all applications submitted within the first 24 hours.


Since the credentialing process is lengthy, it is important not to waste any time. The quicker payor applications get submitted, the quicker we will be able to get approval and the faster providers can begin seeing patients.


Q: What would you say is the first thing you should do when trying to get anew provider credentialed?


A: The first thing to do when credentialing a new provider is to look at the panels he or she will be joining and decipher what is needed for the payor enrollment applications. This might include board certifications, copies of medical licenses, diplomas and so on.


Making sure you have all the required documents is important because it optimizes efficiency. If you are able to send all supporting documents with the application at the time of submission, it reduces the chances of the application being sent back or stalling because of missing documents.


Q: How do you stay up-to-date on changing regulations, codes, and new requirements?


A: It can be challenging to stay up-to-date on all of the regulations and codes. I feel I learn the most from my colleagues. As a team, we make sure we share new information with one another.


Additionally, insurance companies are helpful in sharing new information. It is important to listen to what the representatives are telling you during a follow-up call. They typically want to help and will oftentimes provide insight into any changes.


Webinars are also a great source for industry knowledge. I subscribe to multiple industry newsletters and so does our credentialing team. As we come across webinars, we share with each other and will attend. If we can’t make it, they will typically send a recording that I can watch when I get the time.


With the credentialing industry always changing, it’s important to make sure you are as up-to-date and educated as possible. There’s a lot to know and as I said before, being as knowledgeable as you can of the industry will only help you be better at the job and get the results we all want.


Q: Does credentialing software really keep you better organized and make your job simpler?


A. Credentialing software really streamlines everything. If I need a copy of a document, I know exactly where to look and do not have to waste time looking through all the documents saved on my computer.


There’s a lot to remember, so having everything in one place is hyper-important to being successful in this industry. With credentialing software, I’m able to track and view notes by the payer and when I open a task I will have everything I need in one place.


I am able to keep contact information as well so I don’t have to search Google or sift through my emails looking for the correct number to call.


To me, using spreadsheets or other tracking tools seems antiquated. Credentialing can be complicated but using software really helps keep everything nice and organized.


Q: What piece of advice would you give to other credentialing specialists?


A: I think the best piece of advice I can give is to be open to learning. Things change quickly in this field so being flexible is important. If you do not know how to do something, take the time to research it.


Expanding on what you already know is critical. Recently, I have been trying to learn more about billing and reimbursement so I can be more helpful when providers come to me with these types of questions. Being able to speak confidently about what you are working on is rewarding in so many ways. I’m a firm believer that inquisitive at work will always enable growth.

If you’re interested in learning more about how our team can help medical practices like yours, we’d love to connect! Schedule a time here that works for you with one of our credentialing experts.