Credentialing Specialist
Don't Let Provider Contracting And Credentialing Hold You Back! Learn How Insurance Contracting And Credentialing Simplifies The Process.
Saurage Collective specializes in behavioral health and medical credentialing compliance, providing clients with one-stop credentialing consulting services. We partner with healthcare providers to ensure that their facilities, doctors, nurses, and clinicians are up to date on all credentialing requirements.
The Purpose of Credentialing
The credentialing process plays a vital role in the providing of healthcare services. Healthcare provider credentialing ensures patients that the professionals treating them possess the qualifications, training, and education required by law.
Completing the series of stringent credentialing guidelines holds healthcare workers to high industry standards that are designed to assure patients that they will receive quality care within a safe setting. The verification of these credentials, however, can be a tedious and challenging process. That is where Saurage Collective comes in – to comb through and scrutinize the credentials of practitioners in order to ensure provider compliance.
Credentialing Services
Contracting Services
Rate Negotiating Services
Aspects of Credentialing
The behavioral health and medical credentialing process involves a multitude of steps that are designed to provide proof of a healthcare professional’s qualifications to practice. Background checks and references, work history, and education are assessed to demonstrate competence. Once the standards threshold is met, a credential is awarded.
We Deliver The Industry Standards
At minimum, the documentation and assessment process includes a review of:
- The NPI number
- Professional curriculum vitae
- Copies of the state licenses
- Board certification information
- Proof of professional liability insurance
- References from peers and fellow professionals
- Continuing Medical Education credit documentation
Importance of Credentialing Compliance
The practice of medicine, mental health care, and addiction treatment demands a high level of responsibility from healthcare professionals. These individuals must complete years of education and training before being licensed and credentialed in the healthcare space.
But it isn’t enough to simply acquire the necessary credentials to practice medicine. To remain a trusted provider in the eyes of the state, the industry, and the patient, there must be assurance of ongoing compliance.
As the healthcare industry evolves, so do its practitioner requirements. A Credentialing Specialist is able to oversee a provider’s compliance to any updated standards, certifications, and regulations. This ensures high quality patient care and safety, resulting in cost-savings due to any legal challenges or insurance claims caused by noncompliance.
The Role of a Credentialing Specialist
The Credentialing Specialist is tasked with a vital role within the healthcare industry. These professionals ensure that a healthcare provider is adhering to state and federal guidelines and licensing requirements that safeguard patient safety.
Healthcare industry guidelines and standards are regularly updated. The Credentialing Specialist sees to it that the provider is informed of any changes, and remains in compliance with updated regulations.
The ongoing communication provided by the Credentialing Specialist, as they continually monitor credentials and licenses, allows healthcare providers to practice legally. When a credentialing or licensing issue is identified, the Credentialing Specialist offers guidance and notifies them of the steps required to update or renew the credentials in question.
At minimum, the documentation and assessment process includes a review of:
- Verify educational backgrounds, work experience, certifications, and licenses of healthcare professionals.
- Compliance assessment of organization and healthcare workers; check that all certifications and licenses are up to date and regulatory requirements are met.
- Conduct background checks to identify any factors that might pose a public safety risk.
- Update and maintain the organization’s database to ensure accuracy of medical staff member data and to track expiration dates of licenses.
- Evaluate policies and procedures to ensure the organization meets safety standards and healthcare industry regulations. Update company standards when regulations change.
- Provide guidance on resolving compliance issues and staying current on credentialing requirements.
Related Compliance Services
There are several tools related to credentialing that help to improve overall organizational health. Credentialing is a diverse landscape that includes these services:
- Insurance contracting and credentialing. This involves the process of entering into a health plan’s network. Prior to accepting the provider, the insurance entity must verify that the healthcare provider adheres to all legal, regulatory, and plan requirements.
- Utilization management (UM). UM assesses the use of health care services to ensure patients get quality care at the right cost. It evaluates proposed treatments and services to determine whether they are cost-efficient, appropriate, and reflect quality care.
- Payer analysis. Payer analysis involves the costs of health care and how to best manage those costs. It considers the financial aspects of delivering medical or behavioral health services. Ultimately, payer analysis is a tool to help healthcare providers make informed decisions regarding managing health care costs.
Saurage Collective has extensive experience providing top-notch credentialing solutions to a wide array of clients in the healthcare space. With a deep understanding of the complexities of state regulations, our team will ensure that your medical and behavioral health credentialing process is efficient, secure, and up to date.
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