All About Credentialing: Conquering the Requirements

May 10, 2023 to May 18, 2023

Early Bird Rate: $1195 until April 27, 2023
Cost: $1295
Course Type: Live Webinar

All About Credentialing: Conquering the Requirements

These two Credentialing courses have been bundled with you in mind! Faculty will walk through a detailed explanation of each Credentialing standard for our Introduction to Credentialing course. In our Advanced Credentialing course you will be provided a learning environment to strategize and share lessons learned. Come prepared to interact with our expert faculty and your peers for an opportunity to define, plan and achieve excellence. 

Introduction to NCQA’s Credentialing Standards 

Day One: Wednesday, May 10, 2023 1:00pm-4:00pm (EST) 
Day Two: Thursday, May 11, 2023 1:00pm-4:00pm (EST) 
Day Three: Friday, May 12, 2023 1:00pm-3:00pm (EST) 
Course Expires: February 9, 2024

This virtual course provides an in-depth explanation of NCQA's credentialing standards. Faculty will walk learners through a detailed explanation of each Credentialing standard and lead them through scenarios that are designed to mimic real-life credentialing scenarios. A demo of NCQA’s Interactive Review Tool (IRT) will be provided to guide learners through key steps for submitting documentation for the survey.

Advanced Credentialing: Achieving Performance Excellence

Day One: Wednesday, May 17, 2023 1:00pm-3:00pm (EST) 
Day Two: Thursday, May 18, 2023 1:00pm-3:00pm (EST) 
Course Expires: February 16, 2024

In this interactive course faculty will guide learners in addressing critical performance implications for credentialing. Various strategies and lessons learned will be presented to help professionals define, plan, and achieve excellence in credentialing.  To optimize this experience, this course blends open forum discussions, peer-learning, group breakout sessions and lecture with live Q&A. Faculty will also provide a demo of NCQA’s Interactive Review Tool (IRT) will address the nuances of submitting documentation for the survey.
Course topics are not exclusive to NCQA requirements, but are applicable to NCQA requirements for both Health Plan Accreditation (HPA) and Credentialing Accreditation. A working knowledge of Credentialing will be beneficial for a successful learning experience.

•    Each attendee must register as a unique participant, as required by the NCQA Terms of Use.

Target Audience

Introduction to NCQA’s Credentialing Standards 

This course is geared towards individuals with one year of experience, or less; collecting, reporting, and acting upon credentialing data; or those who need a refresher, including:

  • Credentialing Specialists/Coordinators/Managers/Directors
  • Consultants
  • Provider Relations Specialists/Managers
  • Quality Improvement Managers/Directors
  • Quality Assurance Managers/Directors
  • Regulatory Specialists/Managers/Directors
  • Vendors/Contractors

Advanced Credentialing: Achieving Performance Excellence

  • Clinicians, Directors, Managers, Specialists and Coordinators
  • Consultants, Contractors, Delegates and Vendors
  • Health Plans and Managed Care Organizations
  • State Officials
  • Professionals in Compliance or Risk Management
  • Professionals in Quality Assurance/Improvement or Performance Measurement

Learning Objectives

Introduction to NCQA’s Credentialing Standards 

  • Explain the NCQA Credentialing Standards.
  • Identify appropriate credentialing and recredentialing documentation and operational procedures required to comply with NCQA Accreditation Standards.
  • Describe potential problem areas in the credentialing process.
  • Apply the NCQA Credentialing Standards to assist health organizations in the credentialing process.
  • Discuss and identify the credentialing differences between Health Plan, Managed Behavioral Health Organizations, Credentialing Verification Office and Credentialing Accreditation.

Advanced Credentialing: Achieving Performance Excellence

  • Identify policies and procedures important to the credentialing process.
  • Explain the impact policies and procedures have on NCQA surveys.
  • Define attributes of exemplary criteria for credentialing.
  • Evaluate characteristics of a credentialing committee.
  • Discuss the NCQA requirements for ongoing monitoring.
Course summary
Course opens: 
Course expires: 
Event starts: 
05/10/2023 - 1:00pm EDT
Event ends: 
05/18/2023 - 3:00pm EDT

Candice Costello, BS 

Candice Costello is Assistant Director, Accreditation Operations Projects, at NCQA. In this position, she provides expertise and direction for multiple projects to support operations. She identifies and supports improvement projects to enhance efficiency and reduce product delivery risk, and works across NCQA teams to identify and implement business processes to transition products from design to delivery. Ms. Costello also supports ongoing and annual system improvement efforts for NCQA’s Interactive Review Tool, and supports the development, testing and release of the NCQA’s File Review System. 

Ms. Costello continues to serve as Accreditation Survey Coordinator for organizations seeking Accreditation/Certification, and is an Administrative Surveyor for Health Plan Accreditation surveys. In her previous position as Senior Accreditation Manager with NCQA, she was Account Manager for three large corporate accounts.

Ms. Costello earned her BS in Health Services Administration from James Madison University.

Irv Koehler, RN, MBA, CPHQ, CPC

Irv Koehler is a health care quality consultant for the Koehler Quality Group, LLC. In this position, he is an NCQA administrative surveyor and provides consulting services to organizations evaluating and preparing for NCQA Accreditation/ Certification projects, risk adjustment validation for managed care organizations, education on quality improvement practices and outcome measure development and tracking.  

Mr. Koehler is also a registered nurse with active licensure in Florida and Tennessee, and certification in quality and medical coding. Previously, he was a quality improvement professional at AmeriHealth Caritas and BlueCross BlueShield of Tennessee.

Mr. Koehler has an MBA from the Florida Institute of Technology, a BS in Nursing from Florida Southern College, a BA in Psychology and an ADN from Purdue University.

Veronica Locke, MHSA

Veronica Locke, MHSA is a process consultant with the Health Care Service Corporation (HCSC) in Dallas, Texas. Prior to joining HCSC, Veronica was a consultant for The Mihalik Group, providing healthcare-related consulting services.  Her areas of expertise include quality assessment and improvement; credentialing; delegation; disease management accreditation/certification; population health management; multicultural health care. 

Veronica is the former Senior Manager of Accreditation Policy for the National Committee for Quality Assurance. She was actively involved in the development and maintenance of the standards and guidelines of NCQA's Accreditation and Certification programs, specifically Health Plan, Disease Management and Multicultural Health Care Distinction programs. As a member of the Policy team, one of her major responsibilities was to serve as a content champion when providing policy clarifications and trainings internally and externally. 

She received her Bachelor of Science Degree in Public Health from the University of Maryland, College Park and her Master of Health Systems Administration Degree from Georgetown University in Washington, DC.

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