• Home
  • |
  • Blog
  • |
  • What Is the Physician Credentialing Process?

What Is the Physician Credentialing Process?

November 18, 2021

Health is one of the most valuable things we can have as humans. Valuing not only our own health, but the health of others is why we now have different levels of healthcare available for different people. But how does the physician credentialing process help ensure patients are receiving the best healthcare, regardless of where they are treated?

When physicians get a new job or apply for admitting privileges, they have to go through the credentialing process. This is a process where the healthcare center will be able to validate all of the schooling and credentials this physician claims to have in order to ensure they are qualified.

Here’s a step-by-step guide to the credentialing process and more about how the process benefits both the patients and the physician’s coworkers.

Preparation

If you are preparing to be a physician or are in your residency, it is good to know that a physician credentialing process exists. There are a lot of documents you need to have prepared and ready to give to your future place of employment. While searching for potential clinics or healthcare centers to work at, you should gather all of the following information and make sure you have it on hand before going into an interview or applying for a position. Your documentation should include:

  • Education and training
  • Board certification or eligibility
  • Work history as well as medical staff history
  • History of your clinical privilege
  • References (phone numbers and emails of coworkers and peers)
  • Performance reviews and your clinical reports
  • Malpractice insurance carrier(s) and history of claims
  • Licenses and registrations from federal, professional, and state

It is important to note that your prospective employer will also ask you for an explanation for missing work, training, or education gaps that are more than 30 days in a row.

While you are preparing for your job interview or new position, make sure your resume and any profiles you have set up for your practice are updated for employers to view and evaluate.

When Should You Begin Preparing?

It is never too early to begin organizing and gathering this information. It is a great idea to begin collecting phone numbers and emails of your peers and coworkers throughout your education and training years. During that time, anytime you receive a certification, review, or license, you should file it in a place labeled for your physician credentialing process.

If you have not been doing this and you are now looking into working for a different employer, you should gather and organize these files as soon as possible.

The Physician Credentialing Process

Now that you have gathered all of the necessary information and are formally applying for a new position, you will give permission to the health care center or organization to research and verify all of the information you provided. The organization will consult credentialing providers to being the official process.

The credentialing provider will reach out to the original source to verify to the information accurate. They will be contacting the places you received your education, checking that you actually completed training, and verify any previous work history.

If information is incorrect, partial, or missing details, it can make the process take longer and become very complicated. The credentialing provider will have to spend a lot of time going back and forth between you and the original source to nail down the correct information. To avoid any complications and speed up this process, make sure all the information you provide is accurate and complete.

After the information has been verified, it will be reviewed by medical staff. This medical staff or another governing body will review the information and discuss with the provider and what you can offer the organization.

Another critical part of the credentialing process is the background checks. These background checks will show and expose any negative experiences with this provider. This step is one of the most crucial as it is “reading the reviews” of how a physician has behaved and provided care in the past.

Why Is This So Important?

The credentialing process is done to ensure that people applying for healthcare positions are qualified and certified to provide care. This allows patients to have full trust in their doctors and healthcare providers. As a patient, it can be scary or nerve-racking to trust a stranger with your life and your health. The credentialing process helps to remove some of that anxiety by verifying that a provider is in fact qualified and knows what they are doing.

This process is not only important for patients but for the physician’s co-workers as well. When someone has spent years of their life learning and training to provide care for patients, you want to make sure they are in the best hands. You also want to make sure you can trust your coworker to care for the patient correctly and safely. For employees working at a healthcare center, it is reassuring to know that all employed providers have been checked and verified to work there.

This process also helps the healthcare center itself. Hiring a new physician can be a difficult task. Healthcare centers want to make sure the person they are allowing to work on their patients is qualified and knows what they are doing. This protects not only the life and comfort of the patients but also the reputation of the healthcare center. Hiring a physician who turns out to be unqualified could be detrimental to a healthcare center. They also want to make sure that the physician in question is accurate in the care they provide. Healthcare centers do not want to hire someone who will give faulty information to patients or potentially harm them in any way.

While this process may seem like a lot of extra work to get a position, it is good to understand why this process is in place and the good it continues to do. Without this process, anyone could forge a couple of papers and get a job as a doctor.

Looking for a qualified medical billing service?

By taking just 1 minute to provide some basic information about your practice, you can get up to 5 pre-screened companies competing for your business.

Related Posts

The 12 Best Medical Billing & Coding Companies In Houston, Texas

The 12 Best Medical Billing & Coding Companies In Houston, Texas

The 12 Best Medical Billing & Coding Companies In Fort Worth

The 12 Best Medical Billing & Coding Companies In Fort Worth

The 12 Best Medical Billing & Coding Companies In Dallas, Texas

The 12 Best Medical Billing & Coding Companies In Dallas, Texas

About the author 

Fred Hopkins

Fred has been connecting medical practices with qualified medical billing and coding professionals since 2016. Helping doctors, of all kinds, streamline patient operations along the way.

Leave a Reply


Your email address will not be published. Required fields are marked

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}