Five Pandemic-Proof Tips for Managing Your Credentialing Staff

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By Claire Forgan

Provider credentialing is one of the most necessary components of running a healthcare practice and ultimately getting patients the care they need. However, the operational processes can be burdensome. Employees are burned out, stressed out, and exhausted after the pandemic year. Remote work has exacerbated the problem in many cases, but it also opened up many people to rethink how things worked before and during the pandemic and what can be improved on as we embrace the new normal.

Here are five areas to refresh and reset with your team.

Clearly define roles and responsibilities

The COVID-19 pandemic has pushed many health practices to work remotely, and some are deciding to stay remote. However, without a process in place, this can create communication breakdown for employees. When staff members are not clear on what they need to do, tasks fall through the cracks, especially if employees aren’t able to flesh things out in person. Deliberate communication is key and helps to identify a single owner responsible for a given task or project. Even when there are several team members involved, the individual responsible for the outcome should be clear, whether that’s the subject matter expert (SME) or the project owner. Having a dedicated team member who’s responsible for credentialing measures and knowledge — especially important with so many changes happening right now with credentialing — can go a long way. RACI can be a great tool here to help manage project roles and responsibilities.

Establish timeliness standards

Setting clear and realistic timelines for teams is essential for ensuring the organization and staff members are set up for success. This is where intentional communication comes in again. Set clear standards for your team so there is no ambiguity in time or performance expectations. These standards should be a combination of looking back at past work to get a realistic timeframe, taking into account bigger picture goals, and dependencies. For example, if another team relies on work being done within a certain amount of time, working backwards from there to set timeliness standards to meet those goals is essential. For remote employees, this holds true even more so. Not only will this reinforce internal standards, but it will also aid future planning processes with stakeholders. Additionally, standards should be coherent with overall organizational goals. For example, if the goal is to get providers enrolled with payors within 60 days, timeliness standards should be consistent with that.

Establish documentation standards

There are some parallels between establishing documentation standards and setting timeliness standards. Being proactive and creating solid documentation guidelines for teams in advance reduces potential errors and creates visibility around the team’s work. Documentation should be detailed enough that either a new staff member, a member of another team, or a manager can understand what work has been done, by whom, and when it was done. It’s also important to establish consistency with documentation methods. Documentation that needs to be pulled onto a report should be consistently tracked in a discreet field in the same way by all team members. If a system is being used that has five different status options to indicate work is in progress, pick one and educate the team to use it consistently.There may be a lot of options, but for reporting, plan on narrowing it down. 

Manage team bandwidth

This step can be a bit trickier remotely, but it’s a must-do. The first step: Determine what the “workload number” is. This is the number of work items (applications, verifications, new providers, etc.) that a team member can comfortably manage at one time. Once that number is decided, get feedback from the team. This step will help team members feel like they are a part of the decision making process. Performing regular check-ins to monitor the quality of work the team is doing is key for this process. Team members who manage multiple types of work can be categorized as “level one” or “level two,” based on how time-intensive the work is. This provides some flexibility in distributing each team’s workload among various types of work.

Report back

What does success look like for the manager and the organization? Answering this question is the first step in developing a foolproof strategy. The second step is figuring out how to measure thatsuccess. Using a combination of quantitative and qualitative data to do so is a plus, but quantitative data is usually the most valuable and easiest to collect on a regular basis. 

Turnaround time (TAT) is a prime example of how valuable quantitative data points can be. If a project or task is taking a shorter amount of time to complete than previously measured, that can be an indicator that you’re being more efficient with processes. If metrics aren’t currently being measured, baseline metrics is a start, and from those, goals can be set and communicated to teams. Identifying “at-risk” files is another way to determine where you are in reaching your success goals. Reporting can help to flag files that may be delayed or at risk of poor performance. Start by defining the criteria of what an at-risk file is for the organization (for example, this could be a file that is taking 30% longer than your average TAT for that type of work). Then, look at files that meet that criteria on a regular basis and see how that changes over time. Ideally, this number declines.

Adaptability is key in this new normal where credentialing employees are up against an ever-changing sector in which rules and regulations are changing fast. Utilizing these steps will guide teams and ultimately lead the organization to success. 

Claire Forgan leads Modio Health’s Project Management Office. The PMO manages a diversity of projects, including software implementations, credentialing process enhancements, team workflow reviews, and new product rollouts. Modio is a physician-operated platform making credentialing and career management simple, transparent, and efficient for healthcare professionals.

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