Physician Credentialing: A Guide for Physician Office Staff

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Physician Credentialing: A Guide for Physician Office Staff

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Physician Credentialing: A Guide for Physician Office Staff

Veronica L. Rosas, CPCS

Credentialing providers in a physician practice is a confusing and time-consuming process that can seem daunting to even the most seasoned professional. Between managing the credentialing of new physicians to the mandatory recredentialing that must be undertaken every few years, it is imperative that practice-based credentialing coordinators are on top of their game.

Covering the credentialing process for both hospitals and managed care organizations, Physician Credentialing: A Guide for Physician Office Staff is a must-have, practical, and easy-to-read guide for credentialing coordinators and office managers, whether they are brand-new or experienced. The book walks readers through the required forms, provides suggested timelines, details documentation requirements, and offers tips for multitasking and organizational strategies to maximize efficiency. There is even helpful professional guidance, including information on certification, networking, and education.

This resource will help you do the following:

  • Utilize your time efficiently by knowing all the steps in the credentialing process
  • Stay on top of credentialing in the physician practice
  • Plan ahead to manage credentialing for new physicians while maintaining credentials for current providers


Table of Contents


Part 1: Introduction

  • Chapter 1: Introduction to Credentialing
  • Chapter 2: The Credentialing Application
  • Chapter 3: The Managed Care Credentialing Process
  • Chapter 4: The Hospital Credentialing Process

Part 2: Introduction

  • Chapter 5: Credentialing the New Provider
  • Chapter 6: Recredentialing and Reappointment
  • Chapter 7: Managed Care Organization Contracts
  • Chapter 8: Multitasking
  • Chapter 9: Not All Healthcare Organizations Are the Same 
  • Chapter 10: On Your Own but Not Alone: Networking, Education, and Certification



  • Appendix A: Contracting Checklist
  • Appendix B: Acronym List


Who should read this book?

  • Credentialing coordinator
  • Credentialing professionals
  • Physician practice manager
  • Physician office manager
  • Physician practice administrator
  • Practice manager
  • Office manager
  • Practice administrator
  • Business manager


About the Author

Veronica L. Rosas, CPCS, earned a BS in Journalism from the University of Kansas in Lawrence. She began her career in credentialing in July 2002 as an administrative support secretary for the CHRISTUS Santa Rosa family medicine residency program. After several years of proving her skills in coordinating the credentialing functions within the office, Rosas became credentialing coordinator for the residency program. In the summer of 2009, she received her Certified Provider Credentialing Specialist (CPCS) designation from the National Association Medical Staff Services.

Published: July 2015

Page count: 134
Dimensions: 7x9
ISBN: 978-1-55645-746-3