Rural Health Credentialing Specialist (RH-CS)

What is Credentialing? 

Credentialing is the process by which insurance carriers, facilities, and hospitals verify that a medical provider meets various quality and regulatory standards. Entities do this by reviewing items such as an applicant’s education, medical licensure, state and federal registrations, certifications, professional liability coverage, as well as many other documents. This time-consuming task requires precise attention to detail and follow through.  ArchPro’s credentialing team will ensure that your organization's credentialing files are completed with accuracy and in compliance with regulatory and accreditation standards.

Enrollment refers to the process of requesting participation in a health insurance network and submitting required documentation to third party payers to gain approval into payer networks and allow providers to bill for services.  

ENROLL

Objectives:  This certification is designed to increase your knowledge and competence in the credentialing and enrollment process.  You will be able to demonstrate your knowledge, skills, and abilities in the credentialing processes for your organization as well as effectively navigate the provider enrollment process. 

Primary Audience: Credentialing Staff

Benefits:  Credentialing staff will have the knowledge to:

• Perform credentialing functions to meet documentation guidelines for compliance with regulatory standards and accrediting bodies
• Credential physicians, allied health and other practitioners
• Collect and maintain an accurate practitioner database and analyze verification information
• Direct credentialing processes
• Participate in audits of practitioner files for compliance
• Collaborate with the organizations medical staff to develop and maintain facility specific credentialing standards and procedures
• Understand payer requirements
• Understand mistakes to avoid that delay payer enrollment
• Understand how to navigate the payer enrollment process

Section Breakdown:

• Credentialing overview 
• Committee and Staff Structure 
• Provider Credentialing 
• Primary Source Verification 
• Credentialing Committee Process 
• Provider Recredentialing  
• Privileges 
• Ongoing Monitoring and Compliance 
• Telemedicine
• CMS Regulations 
• Meeting Minutes 
• Fair Hearings  
• File Audit 
• Additional Requirements-Payer 
• Key Legal Cases
• Putting it all together 
• Payer Enrollment Content