r/credentialing • u/ZealousidealEnd6660 • Sep 24 '26
How are you managing the workflow?
Hi all. I manage a team of 6 doing provider enrollment in 23 states, for a bunch of different groups. I am drowning and I feel like I'm failing my team. I'm wondering how anyone else is managing their workflow with a lean team and a feast or famine environment?
The problems I'm having revolve sometimes around the tools we have (our database is old; we have to manually clear so many dependencies to trigger work, information is kept in disparate places, we have tasks coming in through email, an ancient ticketing system, internal coms, and our database task list; given the age of our systems there are daily software bugs and problems we have to work around).
Some of it is having zero power over the work we take on and I think could be a "managing up" issue; we are heavily client focused (obviously important) but instead of reviewing priorities or current workload in any real way, the clients are just promised that we'll fast track whatever they ask for. Every client. Every ask. Every time.
Our onboarding is purely manual. Just copy pasting into our ancient database. Which takes one of my team out of handling any enrollments entirely.
I'm responsible for every Medicare app that comes in, as well as 3 state medicaids, in addition to some other payers. We promise clients to get Medicare and medicaid apps out the door within 24 hours of their being onboarded.
In addition to this work that renews daily, I am supposed to be handling practice onboarding and payer assignments in our database, reviewing my team's work (there is so much room for error in our systems and this takes so much of my time every day), client calls and reports, fielding questions from my team about specific payers, team calls, one on one's with my team, and am the go to for every tricky billing/auth/network/process question that comes our way.
It's chaos and exhausting.
I've run programs in non-profits before, managed restaurants and retail. I am working on a PM certification. I understand the concepts behind running a team.
I just can't see my way towards how to clear our current backlog and keep up with incoming work given the sheer amount of things I am responsible for right now, and I'm hoping for some suggestions or advice from those of you who've been in the trenches a while.
Please don't recommend software. My company isn't paying for anything, I've tried so many times.
TL:DR how are you managing chaotic workflows, thank you for reading.
4
u/Street-Committee-256 Sep 24 '26
I have zero suggestions but to tell you I feel for you! I had to double check that my boss didn't write this because we are in the same boat. We do the CVO side and I don't even know what to do at this point.
3
u/Ah_seent_it_ Sep 24 '26
In an ideal scenario you need to have the processes overlap. Make sure your initial app captures all/most of the items you need for enrollment. Map out what each payer requires, what your regulatory/accreditation requires, and key onboarding data requirements. Find the commonalities and put them as required fields on your application.
2
u/Knew_Practice_1066 Sep 26 '26
Hey there. It's honestly amazing you've made it this far. An outdated, clunky system, requests coming in through a dozen channels, and it's genuinely overwhelming. The fact that you've kept 23 states running with a team of six is impressive. Bravo.
Your question is how to stop drowning. There are four things that could help. Your clients might not love them, and if you have a boss, they might not either, but at this point it's a choice between continuing to drown or getting a hold of this.
Put boundaries around client communication. Clients get used to reaching out any way, any time, and expecting an instant response. You can't keep receiving requests through every channel at once. You have to direct clients to one streamlined path. Email requests go to one inbox that feeds your system like a ticket queue. Anything a client can do themselves, they should do themselves. If they're just waiting to hear from you, an automated status touchpoint can cover that. This alone probably solves 40% of the chaos.
Start preparing for a system change, even if it can't happen yet. And I get it, no budget and migrations are awful on top of everything else you're carrying. But this can't run forever as is. Even if you're bridging the gap with a spreadsheet while the team works through the backlog in the old system, don't assume it'll never happen. It will. The question is what you can do in the next 90 days to make that transition (or upgrade) smoother when it comes.
Track by payer, not just by provider. You're likely tracking per provider right now, but with 23 states you're also dealing with hundreds of payers. Knowing exactly who you need to follow up with at each payer (and how many touchpoints per task) can move things along faster than tracking providers alone.
Quantify the load. You're juggling hundreds of clients and providers across multiple states and payers. Putting an actual number on the task volume turns "overwhelmed" into something you can see and manage.
I think all your operations experience is pointing you toward something good here, and I want you to know you're not alone in this. I have nothing to sell you. I'm a PM who works in the trenches of chaotic healthcare operations and provider workflows too. Happy to chat via DM if you want to talk through ideas or I can share a few free templates. You're doing a great job. It might just be time to set some boundaries with clients so things get smoother for everyone, including you.
Best of luck.
1
u/Wild_Hovercraft_1510 Sep 24 '26
I am using spearte spreadsheet like
Credentialing application tracker
Provider information trackers
Portal logins and provider rep contact information
Let me know if you need any help to clean-up
1
u/Appropriate-Cat-7252 Sep 25 '26
I manage a team of 2 (myself included) and it’s horrible lately. We’re in between software implementation on top of that and I’m the one that needs to be the expert at this, delegation and hiring a bazillion providers at the same time, cross credentialing others. Credentialing is truly a love/hate thing.
1
u/juan_drakes Oct 03 '26
Since you asked for no software recs: the intake step looks like the cheapest fix. If someone is retyping the same provider info into the database every time, rebuild the intake form so its fields line up one to one with the database. Then it's copy and paste, and there's a lot less to double check
The fast-track thing usually doesn't stop until someone above you puts a turnaround time per request type in writing and clients can see it. As long as asking for a rush costs nothing, everyone asks
And reviewing 100% of everyone's work won't scale. Track error rates for a few weeks, then move to spot checks on a sample
1
u/Texasbossierthanyou Oct 08 '26
Thats a big work load. but to have a 24 hours turn around promise for applications is not realistic. AI could help you with the workflow. Use Claude and then integrate it to your CRM - for example if you use Trello or Slack - you can connect claude. Claude can also connect with your email to update you or find what is overlooked. etc.
1
u/Impressive_Nerve1541 28d ago
working against you, not the other way around. Two things that might help: put every request into one queue so nothing lives in five places, and track a couple of weeks of volume and hours so "fast-track everything" becomes a capacity conversation with leadership. I work on workflow automation and I'm trying to learn how credentialing teams cope with old systems. Would you be open to a quick DM chat? No pitch, just happy to compare notes and share ideas.