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This article "Building a Smarter Future: How Our Credentialing Team is Leading the AI Revolution" originally appeared in Fierce Healthcare on Sep 22, 2025.
The Unsung Heroes of Healthcare
When we talk about the most critical bottlenecks in healthcare administration, the credentialing process is near the top of the list. It’s the essential task of verifying a provider’s qualifications, but it's often a time-consuming, manual workflow. Credentialing specialists spend more time on data entry and follow-ups than on the actual work of reviewing verification results and investigating concerns. This creates costly delays, averaging 60 to 120 days, and holds up everything from provider onboarding to billing.
Compounding this challenge is the wave of regulatory pressure from bodies like TJC, NCQA, and CMS. The need for automated audits and continuous quality improvement is more urgent than ever. These regulatory bodies are raising standards across the board, making it more important to balance compliance and speed.
A New Era of Technology in Credentialing
The good news is that we are in a new era of technological evolution. Tech-first platforms, like Verifiable, have already meaningfully reduced administrative burdens and cut turnaround times. The rise of automated primary source verification (PSV) has improved verification times from weeks to mere hours.
But it’s AI and machine learning that are truly transforming our work. They allow for:
- Intelligent document processing that "reads" documents and automatically fills out forms, cutting down manual data entry by up to 80%.
- Anomaly detection that flags inconsistencies for a specialist to review.
- Intelligent workflow routing that prioritizes tasks based on urgency and complexity.
Other innovations like data standardization and business intelligence are contributing to a more efficient, accurate system.
When combined, all of these capabilities result in a transformed experience for credentialing specialists, one that feels less like jumping over hurdles and more like sprinting down the track.
Verifiable's Differentiated AI Approach
At Verifiable, we've taken a unique approach to AI, putting our in-house credentialing team at the center of innovation. These are the experts with decades of experience who have guided our technology investments every step of the way. They're not just users of our technology; they are co-designers, testers, and quality reviewers.
Our AI strategy isn’t about replacing critical human judgment. It’s about building a smarter system that interprets data, compares it against compliance standards, and flags discrepancies, allowing our specialists to focus on the high-value work of quality review and investigation. This human-in-the-loop approach has enabled our CVO services to achieve an industry-leading ~1-day turnaround time and an impressive <0.5% error rate.
The Future of Credentialing is Human-Centered
The future of healthcare credentialing isn't about technology replacing people—it’s about technology enhancing the human element. Credentialing specialists are shifting their focus from tedious data entry to high-level analysis, exception handling, and building relationships. By doing so, they are adding new value to their organizations by better understanding the risk profile of their entire population, providing enhanced service to providers, and accelerating care and payback.
While we are aware of potential implementation challenges like data migration and staff adoption, a solid strategy is built on phased, thoughtful rollouts, comprehensive training, and clear communication. The ROI is clear: lower labor costs, faster billing, and a significant reduction in compliance risks. But no matter how advanced the technology gets, the human-technology partnership will always be the most critical factor. I couldn’t be prouder of our credentialing team for leading the way — showing what’s possible when expertise and smart technology come together to get high-quality physicians to patients faster.
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