Medical Staff Credentialing Professionals have a myriad of responsibilities, from processing applications and verifying credentials, to managing clinical privileging, overseeing the approval process, and ensuring continuous performance improvement. As this is a profession that is consistently growing, we thought it would be beneficial to review a day in the life of a Medical Staff Credentialing Professional. Let’s dive in!
Here at VerityStream, we work with Medical Staff Credentialing Professionals representing different organizations, including hospitals, Credential Verification Organizations (CVOs), and Managed Care Organizations (MCOs). Each professional manages varying credentialing requirements depending on the type of organization they work for.
A hospital’s operational structure depends on its size as well as the type of hospital it is, like a pediatric hospital versus one that provides acute care.
Generally speaking, credentialing in hospitals is impacted by a variety of factors, including:
The credentialing process for a CVO is influenced by its contracts, policies, and procedures; federal and state laws; and regulations and accreditation standards.
The most common accrediting bodies governing CVOs are:
MCO is an industry term used to collectively describe commercial third-party payers, healthcare networks, and health plans.
Their credentialing processes are influenced by:
Regardless of the type of organization that a Medical Staff Credentialing Professional works for, they have several key responsibilities. Their big, general focus is on processing applications and verifying credentials.
After the application is complete, the department chair or medical director (depending on the organization: hospital, CVO, or MCO) reviews the application and makes a recommendation. It’s common for hospital staff to use a credentials committee for evaluations. This committee reviews the application and any supporting documents, along with the chairperson’s/medical director’s recommendation, and uses all that information to make their own recommendation to the medical executive committee (MEC).
In smaller hospital settings, or non-departmentalized hospitals, the application is usually presented directly to the MEC. The MEC then presents its final recommendation to the board, and the board makes the final decision. It’s important to note that though MCOs do not grant privileges, they do determine the applicant’s eligibility for membership/participation, and process requests for privileges to ensure compliance with regulatory standards.
The work done by Medical Staff Credentialing Professionals can be complicated and time-consuming. When tasks require so much diligence, it’s helpful to have tools in place to help keep one organized and on-target. VerityStream solutions can simplify the process through automation. CredentialStream, for example, provides the most comprehensive provider lifecycle management solution available. With CredentialStream, Medical Staff Credentialing Professionals can use a single solution to manage initial and re-credentialing, enrollment, onboarding, expirables management, privileging, evaluation, network management, and much more. Request a demo today, and start improving patient care on your terms.