Senior Director Managed Care RWJBarnabas Health Somerset, New Jersey
Session Description: Credentialing is one of many quality management tools that healthcare organizations implement to monitor patient safety. While most will agree that it plays a valuable role in establishing and governing high-quality provider networks, very few appreciate its impact on strategic growth opportunities. An effective credentialing program has proven to be successful in facilitating rapid network expansion, shortening provider onboarding time frames, improving quality and data management processes, increasing contracting leverage with managed care partners, and significantly enhancing the health of the revenue cycle. During this session, we will establish a common understanding of credentialing in the context of hospital privileging and managed care enrollment, underscore the benefits and risks of delegated credentialing, and provide a road map for organizations interested in expanding into this critical area of healthcare.
Learning Objectives:
Understand the impact of non-delegated enrollment on operations, revenue cycle, compliance, and data management and identify opportunities for process consolidation between medical staff and managed care divisions.
Understand the risks and benefits of credentialing delegation and effectively manage these risks through robust operations and policy structure.
Learn the steps to establish a credentialing program and a delegation strategy for your organization.