Medical Credentialing Consultant

Medical credentialing is one of the most important administrative processes contributing significantly to the quality of medical care. It also plays a vital role in boosting a hospital’s revenue cycle by bringing the best doctors under one roof. Without medical credentialing, no hospital would be able to perform credential verification effectively and efficiently. It is, therefore, hospitals are willing to outsource medical credentialing services to a medical credentialing consultant or medical credentialing company. Based on their requirements hospitals may choose to outsource medical credentialing services entirely from a medical billing company or an independent medical credentialing consultant.

However, before outsourcing credentialing services to a medical credentialing consultant one must ask the following question.

Who is a medical credentialing consultant?

A medical credentialing consultant is a person who holds expertise in medical credentialing. He/she is trained to carry out the medical credentialing process with the utmost accuracy and success. However, a medical credentialing consulate is likely to work independently rather than being associated with a medical billing company.

What is the educational qualification of a medical credentialing consultant?

A medical credentialing consultant is required to have an associate’s degree in health care or a degree in business administration. In addition to this, he/she may also possess a Certified Provider Credentialing Specialist (CPCS) certification from the National Association Medical Staff Services (NAMSS). Having a CPCS certification allows a candidate to become an independent credentialing consultant by establishing his/her credibility to verify the credentials of trained nurses and physicians.

What are the responsibilities of the medical credentialing consultant?

A medical credentialing consultant is expected to undertake the following responsibilities:

• • Credential Verification
  • Reviewing Applications
  • Monitor Certificates/License
  • Compliance Management
  • Maintain Record/Database

The medical credentialing consultant may be working independently but that doesn’t mean he/she has fewer tasks to perform. Even an independent consultant is required to perform all the duties falling under medical credentialing services.

Why outsource medical credentialing to a credentialing consultant?

An independent medical credentialing consultant is driven to perform his duties more responsibly for he/she has bills to pay and a family to feed. This means he/she is dependent on hospitals for his/her finances. Therefore, the medical credentialing consultant will deliver medical credentialing services without any discrepancies and delay in the work.