What does it take to become a successful credentialing specialist?

“It’s probably not a real surprise, but most people in this role are very detail oriented.”

In addition, these self-directed, self-motivated and process-oriented people make up a dedicated team of individuals across our system who are responsible for ensuring providers are credentialed accurately and hold privileges in their specialty to care for patients.

Menta Macy, a credentialing and compliance coordinator at Fairview Health Services, can be counted in that group.

“Personally, most people would be surprised to know that I love all outdoors sports and activities and that I play on a women’s hockey team, but I also love quilting and basketry, and those seem to be more in line with the profession I’ve chosen,” she says with a smile.

Menta oversees the credentialing and re-credentialing process for the University of Minnesota Medical Center’s Medical Staff, which includes more than 2,300 providers. One of her Fairview counterparts, Michelle Toranza, lead credentialing specialist, helps oversee the South Region, where more than 3,200 providers are credentialed.

Great patient care starts here

Ensuring these providers are properly credentialed is vitally important to patient care, as it’s one of the first steps a provider must go through to start his/her their work at a hospital or clinic site.

Employees like Menta and Michelle are on the front lines of not only that work, but other duties, as well.

“Every day is different,” says Michelle. “We maintain schedules, contracts, rosters, onboarding, attend meetings and organize events that involve the medical staff, among many other responsibilities.”

That list also includes things such as:

  • Reviewing provider, reappointment and initial application files to make sure they are complete, accurate, timely and comply with all relevant laws, regulations and policies;
  • Processing applications for temporary privileges and
  • Preparing an accurate summary of all relevant credentialing issues and researching those issues.

“Our number one goal is to be as efficient as possible; however, there are necessary and required elements needed on the credentialing application prior to us granting privileges that can often slow down the process,” says Michelle. “When we are able to create and implement a new process that improves workflow for the providers, that is what makes the Medical Staff office proud.”

Becoming a credentialer

Menta started out as an executive assistant for Hospital Administration in 1986 and, at the time, medical staff credentialing was part of the position.

As more state and federal regulations and Joint Commission standards were added to medical staff credentialing and privileging, it became a position in and of itself, and Menta chose to take the medical staff credentialing path.

“I really enjoy working with physicians and working through issues with Department Chairs and individual providers,” she says.

For Michelle, who has been with Fairview for 22 years, the enjoyment comes from the same source.

“I truly enjoy helping others so they, in turn, can provide great patient care,” she says. “I think a lot of people don’t understand what a provider has to go through to obtain privileges and practice medicine in the hospital setting. Some of the seemingly smallest things we do for the provider can make a huge difference in ensuring quality patient care.”

To find out how you can be a part of our amazing team, visit our career site.