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About this Self Paced Training

Advanced Credentialing: Achieving Performance Excellence

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.  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.

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

Benefits and Resources

• Group breakout session.
• Presentation slides.
• Recording of live session.
• IRT demo.

What You Will Learn

• 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.

Who Should Attend

• 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

Faculty

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.

Continuing Education

This is a non-accredited activity. 
 

Disclosure of Relevant Financial Relationships 

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:

Candice Costello: None
Irv Koehler: None
Veronica Locke: None

Additional Planning Committee Member:
Felicia Khaalid: None

This program was developed in part by NCQA staff.

This program received no commercial support.