5 Ways Provider Credentialing Leaders Can Prepare for Big Spikes

Provider credentialing spikes

Whether you work for a hospital, payer, or specialty organization, provider credentialing is more than a ‘check the box’ regulatory requirement, it is an essential safety component of healthcare.  

Your credentialing process also greatly contributes to the practitioner’s first impression of your organization.  

In our recent webinar, “The Surge is Coming: Prepare Now for Credentialing Spikes,” we dove into the biggest challenges facing healthcare credentialing leaders — including spikes in volume — and showcased strategies for success.   

As we kicked off, we asked the audience to share the biggest challenges they face in their roles and what would help them be more successful. Sufficient staffing/turnover won out with 40% saying it is their biggest challenge, followed by inefficient workflows at 33%, outdated/difficult software at 17%, and maintaining compliance at 9%.   

When asked what would help credentialing leaders succeed in their role, 56% want completed applications with no missing information, 50% want one source of truth to manage provider data, 39% want more resources to manage backlogs, and 31% want automated document collection. 

Here are five strategies we shared to help credentialing leaders prepare for spikes and achieve greater success.  

1. Understand what contributes to credentialing spikes 

Expected spikes include reappointment cycles, new practitioners entering the workforce, and seasonal months (i.e., flu season) when there is an uptick in patients needing care.  

Unexpected spikes can arise from mergers, acquisitions, staff turnover, or sudden changes with contracted groups where new practitioners must be credentialed quickly.  

It’s important to identify when spikes might occur and ask yourself if you have enough staff to handle the volume — and then put strategies in place to offset spikes.   

2. Deploy strategies to streamline credentialing processes 

Start by reviewing and updating processes regularly for efficiency and compliance. Familiarize yourself with basic NCQA and TJC processes to meet accrediting standards and apply industry best practices that improve the credentials verification process.  

Push back on “we’ve always done it this way” responses and be open to making necessary improvements. By simplifying your processes and eliminating unnecessary steps, you can significantly improve efficiency. 

3. Build strong relationships with practitioners 

Early engagement with practitioners and clear communication about credentialing requirements for new physicians are crucial to making a good first impression.  

When you empathize with practitioners and involve them in the process, you foster a positive relationship that is mutually beneficial. Always ask practitioners for feedback on the credentialing process and use that feedback to make improvements.  

Providing support and guidance throughout the credentialing journey enhances practitioner satisfaction and cooperation, especially new providers who are unfamiliar with the process.  

4. Position yourself as a strategic leader 

As credentialing professionals, it's essential to assert your role as strategic leaders within your organization. Begin by actively participating in decision-making processes, advocating for necessary resources, and spearheading improvements. 

Finally, recruiting a competent team and fostering collaboration across departments can drive organizational success. 

5. Leverage technology and automation 

Take advantage of modern provider credentialing software that speeds processes and streamlines workflows. Swap manual document collection with tools that automate it.  

Invest in technology that offers automation and integration with other departments as well as CVO services that can support you during seasons of high volume. Doing so reduces the administrative burden, lightening the load on staff.  

Most importantly, define what success means for your organization and have ways to assess and track it.  

Optimizing credentialing processes requires a multifaceted approach involving process refinement, relationship-building, strategic leadership, and technological innovation.  

By acting on these strategies, credentialing leaders can enhance efficiency, ensure compliance, and deliver better outcomes for patients and members. 

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