What Is a Medical Credentialing Specialist?

Healthcare providers are under a lot of pressure these days. Meeting with patients is vital to support not only their health, but the health of the practice, too. However, errors and oversight can lead to delays in the credentialing process. These delays often hamper a team’s ability to see patients regularly. As a result, practices can lose time, patient trust, and revenue. This is where a medical credentialing specialist comes into play. Here is an overview of this key role and how it can help your operation.

Medical Credentialing Specialists

Medical credentialing specialists ensure that healthcare practices stay compliant with many regulations. If hiring for this position, it’s wise to look for applicants who have received accreditation from an entity such as the National Association Medical Staff Services. Thorough, timed exams certify their knowledge, as well as experience in the field. These specialists keep provider files to record their details and what is needed to complete applications. Also, these professionals renew and apply for different licenses for the practice and its staff.

Credentialing specialists confirm that applications adhere to all proper local, state, and federal laws. For example, if a doctor requests admitting privileges with your hospital, this specialist would aid in that process. The individual would ensure that the doctor is eligible, then keep all records related to that approval. This staff member is vital when it comes to certifying that all governing conditions are met. They also prepare the documents needed for future audits.

Benefits of a Medical Credentialing Specialist

Your practice may not currently have a medical credentialing specialist position. This is more common for new and smaller healthcare practices. Although, there are many benefits of having someone in this role. Let’s take a closer look at some of the most significant ones.

1. Accuracy Maintaining correct records is important for healthcare practices. Insurance payors often “move the target” when it comes to keeping participation status and crucial data continuity. This position takes on that key responsibility, ensuring all records are kept up to date and checked thoroughly for accuracy.

2. Organization A medical credentialing specialist serves as an in-house expert for all payor credentialing and medical privilege processes. This go-to person is chosen to handle all questions relating to these practices, including contracting, claims-related issues, database updates and medical staff renewals. Having one person who oversees credentialing supports an organized operation because records can easily be verified and updated.

3. Audit Liaison In the case of an audit, a credentialing specialist is truly invaluable. They work directly with auditors as experts and data stewards for certifications. These specialists supply the records needed to make the audit process as smooth as possible. Such peace of mind can be a major stress-reliever for administrators.

Why Choose Mavin Health?

Healthcare providers often prefer to devote their time to patient care rather than red tape and paperwork. However, we understand that keeping proper records is important for keeping certain standards. Appointing this responsibility to a trained professional can free up valuable time and effort. That way, you can focus on providing the best care possible for new and current patients.

We’ve gladly supported healthcare facilities with credentialing services for over 20 years. Our clients receive a central database for all their sensitive data and communications. They also get access to a user-friendly Project Management Portal and receive supportive collaboration from our team.

In fact, many clients love our Annual Credentialing Maintenance Plan! This flat-fee-per-provider plan addresses a variety of updates, revalidations, and renewals. We also offer targeted support and online resources related to eligibility issues and requirements. By harnessing our expertise, your team can rest assured that this aspect of your practice is under control. Contact us to learn more about our process and how it can help your practice today.