Today this section will tell about perspective young man we have got in our team last year – you could deal with him by calling Credentialing department and talking to a helpful nice guy named Vitaliy or Will.
He came at WCH and began his career in Billing Department, but once was assigned for credentialing task and realized - this is his vocation. We asked him about his first weeks and he said: “For me when I came in WCH, everything went very smoothly. Colleagues are very friendly and supportive, workplace organized perfectly! When I came to credentialing department I felt support from supervisor Susanna Bekirova and COO of WCH Olga Khabinskay and it was so inspiring!”
What are the daily responsibilities of credentialing department specialist? They include, but not limited by this: compile and maintain current and accurate data for all providers, complete providers credentialing and recredentialing applications; monitoring applications and follow-up as needed, maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers, maintain corporate provider contract files, ensure knowledge of current health plan and agency requirements for credentialing providers, audit health plan directories for current and accurate provider information and etc!
We asked Vitaliy about his recommendations to health care providers as a credentialing specialist and based on his answer this list was combined:
Whether you outsource credentialing tasks or take care of them in-house, assigning a credentialing coordinator to stay on top of deadlines and expiration is a smart move. He or she can send out timely reminders to help ensure that no credentials expire so no denials due to that.
While credentialing 'should' take around 90 days, it is another smart move to give it more - like 150 days. Credentialing with payers must take place on their timeline, and each has its own timeline. Assuming credentialing process will take 150 days, you will be surprised when it takes fewer or at least a delay will not ruin your other plans.
The Coalition for Affordable Quality Healthcare (CAQH) uniform credentialing program is being widely adopted by payers. Physicians who regularly update and attest their information with the CAQH tend to have more efficient credentialing and re-credentialing experiences, so interfacing with this program is worthwhile.
Make sure your office manager or credentialing coordinator maintains complete, up-to-date contact information for every physician. Without direct and actual contacts, dealing with credentialing or re-credentialing issues can take longer than it should. The credentialing process also involves multiple forms submission, and clear communication is essential throughout.
Your state may have its own laws for physician credentialing, and it may have reciprocity agreements based on payer and other state credentialing organizations. If a physician is credentialed with a payer in one state prior to moving to your practice, the payer may streamline credentialing for the new job.
These are five simple and clear recommendations from Vitaliy, which help you to run your practice successfully. Understanding credentialing processes can make a significant positive difference on practice workflow and reimbursement rate. Problems with credentialing can be expensive and drain productivity, so it's important to have a process in place and a plan for ensuring credentialing always remains up to date.
Ok, what is the worst and best experience?
Vitaliy says: “The most complicated issues I face with health insurance plans are denials regarding health care provider enrollment. When this happening I need to find another ways to enroll a provider or make an appeal that obviously takes much more time. The most exciting thing for me is to receive gratitude from clients after my job is done, it makes me feel helpful and really happy!”
Now, let’s talk about future…
Vitaliy sees WCH SB as a leader of providing a variety of services with extremely high quality to health care providers along with introduction new and unique digital technologies in this sphere, as a widely recognized healthcare brand in USA. He also specified innovations, which he expects in health care industry very soon:
Regarding his career plans Vitaliy wishes to be recognized as a successful person who achieved all the goals and have a positive image in people around him: “I will have to work as hard as I can to get that recognition and I am willing to do what it takes to get that point. I approach everything in life with positive attitude and lots of enthusiasm. I strongly believe that I will be a successful person in my whole life!”
We wish the best of luck to our ambitious young man! WCH Family supports you, Vitaliy!
A bit of personal info
Vitaliy was a professional soccer player till 17 years old and still likes this sport. He is also a big fun of computer games and amateur of photography. He loves to spend time with his friends on weekends and go for nature walks.
Vitaliy’s favorite musician is Thom Yorke from Radiohead, his favorite movie is “Fight Club” and book of the same name: “Fight Club” was written by Chuck Palahniuk and I love it because it shows a true face of modern society, tells about reasons we follow fake dreams and it teaches how to find real freedom and peace in your life.”
In his free time Vitaliy likes to do sports, watch movies and play computer games. His dream is to run a business one day, but he did not figure out the details yet.