Anyone who’s had a front seat with medical credentialing knows that it’s an administrative headache. While physician credentialing is unavoidable, there are some choices that you and your organization can make to reduce the burden, bake-in efficiency, and save on time and money.
One of these top decisions is to insource credentialing or outsource by delegating to a certified Credentials Verification Organization (CVO). While both come with pros and cons, we find most organizations lean toward the visibility and data accuracy that in-house credentialing offers, especially as they grow.
If your healthcare org completes credentialing using an in-house team, there are high-impact ways to double (nay, triple) up your medical credentialing specialist’s efficiency. Enter automated medical credentialing software.
Read on as we discuss the ideal insourcing credentialing team size, run some “napkin” math on medical credentialing costs, and share tips for improved medical credentialing.
How Big Does Your In-House Credentialing Team Need to Be?
Whether you’re building an insourced medical credentialing team from scratch or reevaluating efficiencies, the right team (and right-sizing the team) is critical. Determining your medical credentialing specialist team size depends on the number of providers employed in your healthcare system, provider growth, and the use of software (or not).
While there are several variables at play, the average Medical Credentialing Specialist (without software) processes about 80 provider packets per month. A Medical Credentialing Specialist with the assistance of automation software like Verifiable, can expect to process about 250 credentialing packets per month on average.
Automating significant portions of the credentialing process, like primary source verification, packet assembly, and data entry, allows each credentialing specialist to manage significantly higher volumes.
Determining the “sweet spot” for your staffing needs means knowing the number of credentialing events processed per month, growth trajectory, and how quickly the team adopts credentialing software. Don’t worry, we’ll run the numbers in this article (stay tuned).
But first, let’s touch on Medical Credentialing Specialist salaries.
Medical Credentialing Salary
The average annual salary for a Medical Credentialing Specialist or Physician Credentialing Specialist in the United States is pegged at $52,306. This figure translates to an hourly wage of approximately $25.
While location, tenure, and skill may affect pay, the majority of salaries fall between $37,500 (25th percentile) to $66,500 (90th percentile). Top earners make north of $100,000.
Positions such as Certified Professional Medical Services Management (CPMSM®) and Credentialing Supervisor will also command higher annual salaries. These roles often come with additional responsibilities, such as taking the lead on rolling out credentialing software.
Quick Math—Provider Credentialing Costs
The perception that transitioning to in-house physician credentialing necessitates a large, costly team of full-time employees (FTEs) is misleading. In reality, the required number of Medical Credentialing Specialists is quite manageable with automation software
Here is some “back of the napkin” math to illustrate Credentialing Specialist costs:
First, let’s assume that your healthcare organization has a network of 10,000 providers.
Let’s also estimate that re-credentialing is required every 2-3 years. This means approximately 3,333 credentialing events per year, which translates to 278 events per month.
Now, what if your provider network is growing? Let’s say the plan is to add 500 new providers to the network each year. This would result in an additional 41 credentialing events per month.
Given that one full-time Medical Credentialing Specialist can handle approximately 250 credentialing events per month (with automation technology), you would need two Credentialing Specialists to efficiently manage a growing network of 10,000 providers.
How Long Does it Take to Credential Manually?
Now, let’s compare insource credentialing with the help of automated credentialing technology against manual credentialing. Without technology, a full-time Medical Credentialing Specialist can handle about 40-80 credentialing events per month.
With the same network of 10,000 providers and 319 credentialing events per month, a healthcare organization would need four full-time Medical Credentialing Specialists.
Here are a few contributing factors to the longer manual processing times:
- Information Gathering and Verification: Manually collecting and verifying documents for each provider's credentials is highly time-consuming.
- Form Completion: Filling out detailed credentialing forms for each application by hand requires meticulous attention to detail.
- Primary Source Verification (PSV): Direct verification from the sources is a critical step that significantly adds to processing time.
- Follow-ups and Corrections: Manual processes often necessitate additional follow-ups to address discrepancies, further delaying completion.
Save Time and Resources with Credentialing Automation Software
In addition to significant cost savings from a reduced full-time staff size, credentialing automation software comes with a host of other strategic advantages.
Let’s review some key benefits of credentialing software for internal teams:
- Reduce Team Burden: By automating time-consuming tasks like primary source verifications (PSVs), the software significantly reduces the workload on internal teams. This allows staff to focus on more strategic initiatives rather than getting bogged down with manual, repetitive tasks.
- 2x Less Staffing Costs: Credentialing software streamlines and automates many of the repetitive tasks involved in the credentialing process, significantly reducing the amount of manual labor and time required.
- Ensure Compliance: Automation software keeps organizations up-to-date with evolving regulatory requirements, ensuring continuous compliance. It navigates the complex landscape of healthcare credentialing regulations, making adherence to laws and guidelines more manageable.
- Reliable Primary Source Verification: One of the critical features of credentialing automation software is its ability to verify credentials from reliable and authoritative sources automatically. This ensures that all provider information is accurate and up-to-date, minimizing the risk of errors that can occur with manual data entry.
- Adherence to NCQA Standards: The software is designed to meet the National Committee for Quality Assurance (NCQA) standards, a benchmark for quality throughout the healthcare industry. This includes automating the assembly of credentialing packets, ongoing monitoring, and credentialing processes in alignment with NCQA guidelines, which ensures that organizations not only meet but exceed industry standards for quality and safety.
TL;DR: In-House Credentialing Essentials
With the help of credentialing automation software, In-house credentialing offers greater visibility, accuracy, and scalability for many health organizations. Here are some top takeaways on building an efficient, insource credentialing team.
- Manual Processing Time is 3x Greater: Without software, credentialing is labor-intensive, with specialists maxing out at 80 credentialing events per month. With software that automates the physician credentialing checklist, credentialing specialists can handle 250+ events per month, drastically cutting down on manual time.
- Cost Savings with Smaller Team: Automation reduces labor costs, with significant savings in both staffing and operational expenses. Fewer Medical Credentialing Specialists are needed with the right credentialing automation software. The average salary for a Physician Credentialing Specialist is $52,306
- Strategic Benefits of Automation:some text
- Reduces team burden by automating tedious tasks.
- Ensures compliance and adherence to NCQA standards.
- Provides reliable source verification, reducing errors.
- Streamlines the credentialing process, saving time and resources.
Verifiable offers an efficient medical credentialing solution by accessing hundreds of primary source verifications to automate the entire process. With time-stamped audit logs and reports, Verifiable ensures that your organization is always audit-ready and compliant with credentialing standards.
Simply, we make medical credentialing all a whole lot easier. Get a demo today to see how your medical credentialing team can save thousands of hours.
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