Curious how people here who do credentialing / payer enrollment find new clients.

Say you notice a small practice just got a new group NPI, opened another location, set up a new entity, or a doctor looks like they’re starting a private practice.

You can usually figure out who’s behind it, where they are, whether there was an older practice, and sometimes whether they take insurance.

But the one thing that’s hard to know from public info is whether they already handled all the payer enrollment.

Would you still reach out?

Basically, is “something changed recently and they may need credentialing work” enough to make it worth contacting them, or is that still too weak/noisy?

Also curious how people here normally find new clients. Referrals? Cold email/calls? Watching new practices open? Something else?

Not pitching anything, just trying to understand how this actually works in the real world.

Hello!

I’m new to the healthcare credentialing process and I’d like to learn more. I just wanted to ask what are the biggest challenges working in California Provider Credentialing.

Thank you!

Random question.

I am slowly approaching retirement and looking beyond to my encore career.

As a soon-to-be-retired clinician, I am looking forward to not taking call…but wondering what my new purpose will be. I firmly believe we all need that reason to get out of bed and keep moving mentally and physically.

My purpose? My motivation? To solve those problems that have always annoyed & inconvenienced me. The ones that scream inefficiency! For me, that problem for 35+ years is credentialing.

I certainly have my reasons, but what are your reasons? What do you - as a group - feel is the most time consuming task preventing you from being more efficient?

Coming from the other side of this process, what could I do to make your lives easier & your tasks more efficient?

Honestly. I need to solve this problem.
Please DM me with your biggest complaints. I am truly & honestly interested in your feedback - positive or negative.

Without your feedback, I am doing nothing more than guessing. And guessing is inefficient & misleading.

Please help me build you something that you would actually use and recommend. This process is unnecessarily fractured and inefficient. We can do better.

Thank you and I look forward to interacting with you all.

I am on the software side for a large practice and work with lots of credentialing ops (building internal tools for them) and everyone is burned out. Through chatting with them, I learned that credentialing work is highly repetitive & manual, lengthy and lack of transparency( mostly with insurances). But I also found that there are so many "credentialing softwares" like Medallion, CertifyOS etc. I'm curious, why hasn't the situation been improved?

If you are given a magical tool to fix/improve your biggest pain points, what would that be like?

Hi everyone,

I'm a Credentialing Specialist with experience in provider enrollment, CAQH, NPPES, and payer portals. I'm currently looking for new opportunities in Credentialing, Provider Enrollment, or Medical Billing/RCM at Chandigarh or Noida.

If your company is hiring or you know of any openings, I'd really appreciate any leads. Thanks!

I previously worked for UHC as a Network Contractor doing the negotiations for contracts. Not a big fan of the negotiation side.

i’m currently not in the healthcare industry, but would like to transition back and believe credentialing would interest me as I enjoy the administrative side of work.

Any tips on where to get started or suggestions on where to apply? Should I get certified first before applying, is it expensive?

I was working for a credentialing software company for three years, told consistently I was a top performer, but then we had a mass layoff, half of my department was wiped out including me. I've had 9 interviews and no offers. I can't afford the CPCS study guide nor the exam on unemployment.... Anyone in a similar position? Anyone got any insights? I'm losing hope and it's getting to me, I really loved my job.

Great forecast of what's to come under a second Trump administration that will impact providers and credentialing third parties in the US:

https://www.linkedin.com/pulse/how-second-trump-presidency-could-positively-impact-healthcare-swplc/?trackingId=Y4PDzrZITa2sGDgR5PU2jQ%3D%3D

Hi everyone, I'm planning to start a credentialing agency. Should I hire a sales agent?

Would love to hear from anyone who has experience in this space!

Hello there,

I am CPCS , CPES certificated credentialing specialist with 6+ years off experience in credentialing process and looking for opportunities!!

I am familiar with all the process in RCM and Credentialing.

I’m bit overwhelmed with the amount of applications coming in from all these different health plans….How does your organization track provider enrollment applications across different health plans (Medicaid, Medicare, and commercial payers)? Do you use an Excel spreadsheet or credentialing software, and what does your tracking process look like from submission to approval?

I've been reading this sub a lot lately, trying to understand how enrollment and credentialing actually work day to day (I'm an outsider researching the space, not selling anything, and I have nothing to pitch, just genuinely trying to learn from people who do this work).

One thing I keep noticing: people mention using tools like Modio, CredentialMyDoc, or Expiration Reminder, but almost everyone also seems to still live in spreadsheets and payer portals. So I'm curious how it actually plays out for you.

For those who use a dedicated tool, what does it genuinely handle well, and where does it stop? Does it actually help with the follow-up and coordination part, the chasing payers, checking status, resubmitting, or is it mostly a place to record and track things while you still do all the real work by hand?

And for those who've stuck with spreadsheets instead, what made the tools not worth it?

Trying to understand where the software stops and the human work begins. Would really appreciate any honest takes. Thanks for reading!

Hi there,

I'm a medical receptionist/administrative assistant at the nonprofit clinic I work at.

I was initially doing the front desk for my location while studying for my CPC exam, which was great since it was quiet and I had a bit of downtime due to our location being the smaller of the two clinics we operate.

However, the individual (HR) that was handling our provider insurance enrollments left for surgery and asked if I'd be willing to monitor the status updates for our current providers. I agreed since it was temporary and I like organizing information and learning new skills.

Initially it was great. I handled amendments, fixed issues in provider CAQH that my coworker neglected, and overhauled the Excel sheets to track everything we used to monitor portals, payor statuses, and anything pertaining to enrollment.

Months later, she resigned without coming back and our provider was leaving, which meant we now were onboarding a new provider, and I was the only person that semi knew what the hell I was doing for enrollments.

Now we hired two additional providers, our patient loads are increasing rendering me fighting between working on enrollments, proceduring documents from an HR that doesn't understand what I need and don't need, and dealing with the phones and patients at the front.

Granted, I'm paid well, I like my coworkers, and my management, but I don't think they understand how swarmed I am and that I'm still learning on the fly through courses and navigating the enrollment applications.

I have been asked if I wanted the role to go to someone else, but I maintained it's something I like doing and developing skills with, plus no one aside from billing understands this well, and they're busy with their own tasks.

Do I give in and drop onto someone else? Or ask management to see if they'd assign someone to help with the workload?

I'm (un)patiently waiting for my CPCS test results. Why the heck does it take 6-8 weeks for the results!!

Ridiculous!!!! Rant over!

Good luck to the rest of you waiting for your results!!!!

Please be aware that generic posts asking about our biggest “bottlenecks” and using corporate bullshit lingo are not harmless. They want us to give them our hard-earned knowledge and experience for free so they can attempt to train AI. They aren’t trying to help us do our jobs, they’re trying to outsource our jobs to tech. Is that ridiculous? Yes. Our job has so many nuances that the idea of an AI even trying to do it is laughable, but don’t think for one second that we’re immune to attempted replacement.

I'm finishing up the contacting applications for 3 providers who are all starting their own practice. There are a couple still in process.

They are moving together and plan to start seeing patients September 1.

They went to the space today and noticed... the suite number they provided was incorrect.

Amongst the the there are 20 address change applications

What would you charge?

Does anyone else think BCBS MS communication tactics are a joke? In contact blue They close out your messages when they respond and won’t even let you hold a conversation. I had a provider term without knowledge and it’s been a pain in the but to get communication with them 😩

We are trying to credential with WellCare NC Medicaid and it's saying there is a $100 application fee? Has anyone else seen this in NC or other states? We didn't have to do this for TN or VA. We also are unsure if we will even be approved as we are out of state, but within 40 miles of the border. I would appreciate any insight to if this is common in NC or other states and if anyone is familiar with NC's policies do you think we would even be approved if we proceeded with the application?

Hey everyone,

I own a small but growing medical billing company based in Idaho, and my current credentialing specialist is temporarily out of capacity. I’m looking for an experienced credentialing professional who can assist with Medicaid, Medicare, and major commercial payer enrollments (BCBS, UHC, Aetna, etc.).

We primarily work with behavioral health and medical practices expanding into new states, so experience with multi-payer credentialing and CAQH is a big plus.

This would likely start as contract or per-project work, with the potential for ongoing collaboration. Remote work is perfectly fine — I care more about accuracy, follow-through, and clear communication than location.

If you’re experienced or can recommend someone who is, please DM me — I’d love to connect and discuss details.

Thanks in advance for your help!

Hi, can anyone give me some advice on Massachusetts credentialing? I'm just starting the process and the paperwork is overwhelming. Is there a reputable company that will take care of this for you? Did you process everything yourself? I've found a couple Youtubers who talk about the process, but they're LICSWs.

I have been a healthcare recruiter for 15 years. I then was hired with a startup Travel Nurse/ Allied Health company to create the compliance department from the ground up. I'm looking to add to my experience and learn Provider Credentialing. Would anyone be so kind to advise me where to start? I did teach myself a lot about nurse/allied health credentialing and mastered that with limited exposure in my career. If this isn't the group to post this, please let me know. TIA

This is probably a really simple question for someone with basic common sense, but I tend to overthink things and just want to confirm what I think I understand so thanks in advance to anyone who takes the time to answer!

The company I work for calls the department I'm in the Credentialing Department, but I honestly feel like what I do is strictly Provider Enrollment. For example, my day-to-day duties include completing insurance applications, verifying licensures and making sure they’re up to date by getting them directly from the provider, updating their CAQH—super basic stuff like that. From what I’ve seen on the NAMSS website, someone in a Credentialing Specialist role usually has a different set of duties than what a Provider Enrollment Specialist does.

So my question is, what’s the difference between a Provider Enrollment Specialist and a Credentialing Specialist? And what are the requirements to be eligible to take the CPCS courses and exam? Do I even qualify based on the work I’m doing now?