Certified Credentialing Experts: Guaranteed Compliance, Faster Payments

With the rapid advancement in tech tools to secure medical data and streamline processes in healthcare, outdated methods of provider verification are no longer advisable. 

As an expert credentialing provider, TheCredentialing knows the consequences of negligence in such a critical aspect of medical billing. Hence, they offer healthcare organization and individual providers smart and reliable credentialing services. 

Considering a prolonged provider enrollment and credentialing, spanning over 90-180 days, causing the delay with the revenue loss of around $600,000 per provider during the 90-day onboarding period, TheCredentialing turns your credentialing hurdles into result-driven efficiency.

Explore in this crucial guide the other common challenges also, and how the certified credentialing experts, like theCredentialing Experts, overcome those issues to help medical firms stay ahead in revenue stability and reputation. 

Moreover, if you are interested in becoming a certified credentialing specialist, this guide best suits your search. Stay focused and keep reviewing the details. 

Why It’s the Best Time for Medical Firms to Overcome Traditional Credentialing Obstacles? 

Medical credentialing services is a cumbersome and resource-intensive process, leading the providers to complexities in terms of data privacy and security. There are other backlogs also causing the deficiencies. See what some common credentialing challenges the statistics have reported, along with their impact on the overall practice: 

High Staff Turnover 

The year 2022 saw the turnover rates ranging from 19.5% at hospitals to 65% for at-home care providers. While 57% of the organizations have faced credentialing hurdles due to staff turnover over the past years. It imposed a financial and logistical burden on healthcare organizations. Such length turnover impacts the practice’s operational capacity and creates issues in the credentialing process. 

Practices reliance on manual processes and methods

One of the 2021 surveys found that 73% of healthcare organizations reported the usage of legacy systems. The causes and consequences of such practices were an impeded provider's ability to manage provider credentialing and other operational tasks. 

Issues in compliance and verification 

Compliance is the most critical aspect of the credentialing process that requires complete attentiveness. The data reports that 85% of credentialing applications contain errors and incomplete provider information. Common issues arise in these practices, including expired licenses, incomplete primary source verification and delays in enrollment. Such negligence causes compliance failure, financial penalties, and service interruptions. 

Complexities in data management 

Data in medical practice is what all medical entities are most concerned about. Yet, the management of a large volume of medical data is the most critical task. Credentialing organizations have the primary responsibility to deal securely and with accuracy in the process of data collection and storage.

Such tasks create complexity as they take extended time, while errors are most likely to become part of the practice. 

Technological limitations

The reliance of many healthcare organizations on outdated systems creates hurdles to efficiently address the modern-day credentialing challenges. Outdated methods in credentialing lead to practice inefficiency and increase human errors. 

Considering the scenario, medical firms have many reasons to shift their approach and practice of credentialing providers. TheCredentialing digital portal is an efficient automated system to manage aetna provider enrollment data securely while offering access within seconds.

Our automated system helps healthcare organizations and individual providers reduce the need for extended processing times, eliminate errors and improve the best efficiency. Reduce your operational efforts in credentialing when TheCredentialing automated systems offer smart solutions to keep your practice finance healthy, while patient satisfaction improves. 

Certified Credentialing Experts are Essential, Not Optional: Understanding Why is the Need! 

Credentialing a single provider takes around 90 to 120 days, which costs a healthcare organization about $7,000 to $8,000 per provider. These charges can cause physicians to lose over $50,000 in delayed revenue.

Moreover, manual processing makes the administrative burden more critical, with providers spending more than $2.1 billion annually on credentialing. On the other hand, application errors increase compliance risks for the practices that face penalties from the authorities, such as The Joint Commission and NCQA, compromising both revenue and accreditation. 

Therefore, the healthcare firms are tending towards the reliance on experts’ skills and expertise. Certified credentialing experts are the need of the hour as credentialing requires specialisation. For instance, the credentialing has up to 200 checkpoints per provider file that should be scrutinized with complete attention.

 Reports say that only 23% of credentialing applicants have a relevant certification. Plus, the average tenure of credentialing staff is less than 2 years, which causes the inconsistency and loss of institutional knowledge in the credentialing process.

The healthcare industry keeps evolving with the standards, and credentialing is no exception. For instance, adhering to the requirements of NCQA, HIPAA, Medicare conditions, and timely re-credentialing, all these practices pose challenges for providers to maintain efficiency. However, certified credentialing professionals maintain the integrity of healthcare systems with their expertise and specialised knowledge.

Moreover, these experts ensure patient safety and satisfaction with the practice through the utilization of expert resources and compliance with regulations. Below are some key areas: 

Certified credentialing experts in maintaining the practice's credibility & overall quality of care

Outsource your credentialing to the experts, and rest assured, these professionals will leave no room for gaps in practice. Ensure the following key areas are safe with their integration: 

• Through proper provider enrollment specialist, your patients will gain the trust that they are receiving safe care. 

• Verified credentials build trust and confidence in the healthcare system.

• Credentialing doesn’t allow unqualified providers to perform care that may lead to harm or even death. 

• Credentialing accuracy reduces the risk of malpractice or errors as it confirms that the providers have the required training and skills. 

• Proper credentialing also helps practices in eliminating the chances of disputes, and providers meet the necessary standards. 

• Credentialing confirms the likelihood of insurance reimbursement from the payers. 

• Credentialing limits the number of reimbursement denials and maintains the practice’s financial stability. 

• Through credentialing, healthcare organizations maintain compliance with healthcare regulations and accreditation standards set by government agencies like the Joint Commission. 

How to become a Certified Credentialing Specialist?

A credentialing specialist has a valuable position in the entire process in terms of document collection and verification of provider qualification and licensing. When all the credentials are verified, these experts apply to each payer to enrol the provider in an insurance network.

Moreover, these experts are also responsible for the follow-ups. They keep in contact with the insurance payers to identify the application status for further proceedings. These specialists identify the information gaps, collect the remaining data from providers, and relay it to the payer immediately following the payer's requirements. 

If you are concerned about how to become a certified credentialing specialist, you will need a bachelor’s degree to start the career. The healthcare authorities prefer a bachelor’s degree in business, administration, or a related field.

However, Some employers also prefer the associate degree or relevant work experience in the healthcare administrative role. Although you are on the journey towards credentialing specialist education, many of the courses in medical terminology, healthcare management, or health information systems may significantly help in building the foundation of knowledge. 

Beyond your formal education, your role as a credentialing specialist will also require practical experience and on-the-job training. Explore the opportunities in credentialing certifications, such as those offered by the NAMSS (National Association of Medical Staff Services), to further enhance your career credibility and credentialing expertise. Below are some of the reasons why you should seek credentialing certifications by the NAMSS: 

• More than 27% of certificants by the NAMSS received a salary increase. 

• Achieving a CPCS designation will boost your confidence and enable you to demonstrate professional competence while applying your knowledge. 

• CPCS certifications will enhance your recognition and respect from your peers and supervisors. 

What are the CPCS exam eligibility requirements? 

If you are looking for how to become a credentialing specialist with no experience, these guides are crucially designed for you to focus on the requirements: 

• Must have at least 12 consecutive months of employment in the medical services profession within the last 24 months.

• Must have a total of 3 years of experience in the medical services field within the past 5 years.

• Required to have direct, hands-on experience in credentialing, privileging, and primary source verification.

• Experience must include application of accreditation standards (e.g., TJC, NCQA).

• Florida medicaid provider enrollment experience alone does not qualify—the focus is on credentialing tasks, not facilitation.

• Candidates must be actively involved in core credentialing functions as outlined in the Exam Content Outline.

How to become a certified provider credentialing specialist online? 

To become a certified provider credentialing specialist online, you will start by gaining at least one year of credentialing experience. The next step is to get enrolled in an accredited prep course, such as those offered by NAMSS or AAPC, to study key concepts. Finally, apply for and pass the CPCS exam through the National Association of Medical Staff Services (NAMSS).

Many institutions now offer CPCS (Certified Provider Credentialing Specialist) online. For instance, the NAMSS Credentialing Specialist Online Certification Preparation Course is an online program. Through this specific program, you will be able to assess your knowledge of the CPCS exam and identify further knowledge requirements before the exam. 

This program is a comprehensive and on-demand online course which offers a high-level overview of exam topics such as credentialing, privileges, primary source verification, and compliance standards in the credentialing process. 

TheCredentialing Digital Portal: Seamless Integration Guaranteeing a Strict Compliance Management 

TheCredentialing digital portal offers complete security while following the strict compliance rules. Our automated system is integrated with key platforms like CAQH, NPI, PECOS, EDI, EFT, and ERA. Users can have the facility of real-time tracking and primary source verification of provider data. Such direct access and integration reduce errors while accelerating the enrollment timelines.

Moreover, integrating these systems maintains strict compliance with TJC, NCQA to ensure patient safety and provider participation in major networks. While compliance with CMS and HIPAA standards ensures safe billing and reimbursement from insurance providers, and patient data security to avoid legal disputes and data breaches. 

TheCredentialing digital portal features automated updates, exclusion management, license tracking, with the feasibility of customizable dashboards. It not only streamlines credentialing but also protects your organization from costly delays and compliance risks. Explore further the digital efficiency and reduce administrative burdens, and improve data accuracy. We help healthcare organizations onboard providers faster, bill sooner, and safeguard their revenue cycle efficiency.

Key features of TheCredentialing portal, improving credentialing for faster payments: 

• Automated credentialing management 

• One-click renewals and applications 

• HIPAA-Compliant 

• Real-time status update

• Document storage and organization 

• License and compliance tracking 

• Customizable dashboard 

• Exclusion management 

• EFT & ERA Enrollment 

• Custom query feature 

• Duty Roaster Feature 

• 24/7 dedicated support 

• Multi-provider and Multi-location management 

• Seamless integrations (e.g., CAQH, NPI, PECOS, EDI, EFT)

TheCredentialing: A Source of Guaranteed Compliance & Fair Reimbursement. 

TheCredentialing is a certified credentialing expert that combines automation efficiency with effective compliance knowledge. We accelerate provider enrollment and credentialing to expand their insurance network and enhance their patient base. Our digital portal for credentialing integrates with the CAQH to offer real-time credentialing application status updates and EFT/ERA enrollment that reduces onboarding time by up to 20%.

Our digital credentialing means quicker billing and strong practice cash flow that stabilises a healthcare practice’s revenue and reputation at the same time. Make sure, in your search for a free certified credentialing expert, you do not get misguided, as it is a standard operation that requires resources as well as time to meet the quality standards.

However, several practices may offer the process affordability while supporting materials and automated efficiency. This will be your top choice and suiting strategy. 

Frequently Asked Questions (FAQS): 

What is the CPCS certification cost?  

CPCS certification cost varies depending on the course setting and services. For instance, an online exam costs around $349-$399 for one attempt. On the other hand, an in-person exam costs $449-$499, offering two exam attempts. 

What is the Certified Provider Credentialing Specialist salary? 

Currently, the average certified provider credentialing specialist salary ranges from $42k-$67k. Moreover, the average salary is around $ 53,816. 

Are there free certified provider credentialing specialist certification programs? 

Currently, there are no free certified provider credentialing specialist certification programs, nor the availability of free CPCS certification training online. However, there are many affordable online programs to help you prepare for the CPCS exam.

These include the AAPC Credentialing Specialists Course, NAMSS CPCS Online Certification Preparation Course, and the Institute for Credentialing Excellence (I.C.E.) Credentialing Specialist Certificate Program.