SERVICES

Management, Consulting, Training, and Delegation Oversight

 

If you answer yes to any of these questions, you may need my help.

 

  • Have you assumed responsibility for managing credentialing and provider data and don't know where to start? To ensure the department runs smoothly, you need to know the little details that can cause delays or failures.

  • Are you a new health plan or IPA and just realized how daunting the administrative requirements of credentialing can be? Let me help you streamline and build an effective credentialing program.

  • Are you preparing for accreditation or certification? Let's get you prepared and set-up for ongoing maintenance. You will pass with flying colors.

  • Do you need a coach or does your staff need one? Sometimes, you need to talk through the credentialing problem to find a resolution. Or, maybe you just need a sound operational manual or clear-cut policies and procedures. Let us create one specific to your organization.

  • Does your staff need their training reinforced? Training can be customized to meet their needs.

  • Do you have staff new to the credentialing profession and/or accreditation requirements?  Consider our online courses.

  • Are you falling behind on your enrollments? Your providers need to get paid.

  • What about delegation oversight? Do you need assistance performing surveys to ensure your delegates are compliant?

  • Are you interested in becoming a delegate for a payor? Let's make sure you are ready to pass their audits with flying colors.

  • Are you overwhelmed by the number of credentialing applications you have received? Let us help you find the right solution.​​

CONSULTING
  • Building a new credentialing program/department

  • Analyzing an existing credentialing program

  • Creating or revising policies and procedures, operational manuals, documents

  • Preparing a credentialing program for accreditation surveys

  • Analyzing organizational readiness for delegation arrangements and audits

  • Auditing files for performance improvement and/or regulatory compliance

MANAGEMENT
  • Let us due to the daunting, labor driven tasks:

    • Process applications

    • Enroll providers

    • Conduct delegation audits

  • Whatever you need to outsource; or 

  • Whatever you need managed.

Type of training:

  • One on One Coaching

  • On-Site Training

  • Virtual Presentation

  • Online Courses

 

Topics include, but aren't limited to:

  • Basic Credentialing

  • Accreditation Guidelines

  • Policy Creation

  • Provider Data Management

  • Provider Enrollment

  • Time Management

  • Productivity

  • Accountability

 

 

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DELEGATION OVERSIGHT
  • Represents payors to conduct pre-delegation and annual delegation audits.

  • Audits documents that include:

    • Policies and Procedures​

    • Ongoing Monitoring Logs

    • Credentialing Committee Minutes

    • Performance Monitoring

    • CMS Compliance Training

    • Hearing and Appeals Processes

    • and More.

  • Audits initial and recredentialing files per NCQA, CMS, and state regulatory requirements.​

  • Whatever is specific to the payors' needs, we will audit for compliance and provide objective final reports with recommendations.

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© 2014 The Right Credentials

THE RIGHT

CREDENTIALS

 

INFO@THERIGHTCREDENTIALS.COM