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Provider Credentialing Consultant

Provider credentialing is the one of the important administrative process which contribute significant in to the quality of medical care. It also plays an important role in providers revenue cycle management to reimburse the deserving amount from payers. Without credentialing, providers cannot perform credentialing verification effectively and efficiently. This is the reason, providers are willing to outsource provider credentialing services to credentialing consultant or medical credentialing company. Based on providers requirements hospitals, and providers may choose to outsource provider credentialing services entirely from a medical billing company or an independent provider credentialing consultant.

Who is a provider credentialing consultant?

Provider credentialing consultant is a person who holds experience and is aware of all credentialing rules and policies. He/she is trained to carry out the provider credentialing process with the highest accuracy and success in timely process.

What is credentialing process of providers?

Credentialing is the process by which a health insurance carrier formally assesses a provider’s qualifications, and competency based on demonstrated competence. This can be a time-consuming process, and often takes up to six months to complete. The reason for the lengthy process is the requirement for submission of extensive background information. Depending on the circumstances, the clinic or organization for which the provider is working may also need to go through credentialing.

The Center for Affordable Quality Healthcare, Inc. (CAQH) is one of the most frequently-used Web services for credentialing. CAQH offers an online database called the Universal Provider Datasource (UPD) that collects all of the information required for credentialing, and then makes it available to third-party payers.

What is the educational qualification of a provider credentialing consultant?

Provider credentialing consultant is required to have an associate degree in the healthcare or a degree in business administration. Additionally, consultant may also possess a Certified Provider Credentialing Specialist (CPCS) certification from the National Association Medical Staff Services (NAMSS).

Credentialing specialists can get certified through the National Association Medical Staff Services (NAMSS) if they have at least 3 years of experience in the medical services profession and have been employed for the past consecutive 12 months in a medical services position.

What are the responsibilities of the provider credentialing consultant?

Following are the responsibilities of credentialing consultant:

  • Compliance Management: Check regulations, credentialing standards, and policies required of all medical environments;
  • Review: The credentialing application, review, and approval process;
  • Resolve Challenges: A range of physician licensing challenges and regulations on a case-by-case basis;
  • Monitor Certificates: The privileging application and approval process;
  • Recredentialing and accreditation policies and documentation;

Why outsource medical credentialing to a credentialing consultant?

By outsourcing provider credentialing to a professional organization like Medisys, you not only reduce the burden of your current staff but also ensure the top priorities of your organization do not get shuffled to the bottom of the stack. Single error or mistake within the credentialing process could literally bankrupt your practice.

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