The 2025 State of Payer Enrollment and Credentialing

2025 is here. Is your team ready?

The provider operations playbook is always changing, but we've been paying attention to what's working and what's not. We'll cover the trends and tactics to build into your 2025 provider operations strategy.

Acknowledgments

2025 Survey Methodology

Medallion conducted the 2025 State of Enrollment and Credentialing survey in the United States between October 16 and November 8, 2024. A randomly selected sample of healthcare organizations, including provider groups, hospitals, health systems, payers, and virtual-first companies, was invited to participate. In total, 507 respondents completed the survey.

Foreward

The past year has brought significant challenges and opportunities for healthcare operations. With economic pressures mounting and the healthcare landscape evolving, organizations are being pushed to rethink how they approach payer enrollment and credentialing.

Despite advancements in technology, artificial intelligence (AI) and automation, many teams remain hesitant to fully embrace these solutions, choosing instead to maintain manual processes that feel familiar. This fear of technology and loss of control over workflows is creating bottlenecks that affect revenue, patient care, and staff morale.

In preparing this year’s report, we gathered 507 responses from credentialing specialists, operations leaders, and executives. Their insights have given us a clearer understanding of the challenges they face and the strategies that could transform their workflows.

The findings in this report reveal a common thread: while technology has the potential to solve many of the industry’s challenges, adoption remains slow. Even so, the resilience of healthcare teams shines through. They continue to adapt and innovate, finding ways to navigate complexity while keeping patient care at the center of their work.

Our mission at Medallion is to empower these teams with tools that simplify their workflows, reduce administrative burdens, and drive better outcomes. We hope this report provides actionable insights that inspire you to explore new ways to increase efficiency, unlock revenue, and focus on what matters most: delivering great care.

The Medallion Team

Chapter 1: Ways of Working

Performance and provider operations work

Staffing challenges and manual workflows are putting a strain on operations teams. From team morale to operational efficiency, the systems they rely on play a critical role in their success—and their ability to deliver care.

What you'll find in this chapter

Turnover disrupts operations
51% of payer enrollment and credentialing teams experienced turnover in the last year, causing workflow challenges and revenue delays.

Teams are stretched thin
56% of respondents feel their teams are understaffed despite most organizations having no unfilled positions.

Manual processes dominate
Manual work remains prevalent for enrollment-related tasks such as verifying application accuracy (65% manual) and following up with payers (63% manual).

Current state of teams

Enrollment and credentialing teams reported a turnover rate of 51% in the past year

Employee retention is a universal measure of team morale, job satisfaction, and collaboration. In healthcare, these numbers take on even greater significance. High turnover doesn’t just affect operations—it disrupts care delivery, delays revenue, and piles more stress onto already overburdened teams.

The stakes couldn’t be higher. Healthcare organizations are bracing for a nursing shortage projected to exceed one million by 2030, while also facing increased patient demands and a rapidly evolving regulatory environment, compounded by the proposed new governmental policies, which emphasize deregulation and prioritize healthcare access and cost management. 

These factors collectively intensify the pressure on healthcare organizations to maintain stable and efficient teams.

A deep dive into staffing levels

While turnover has improved by 10% compared to the data from last year’s report, challenges remain. Manual processes leave teams especially vulnerable when key staff members depart. This disruption often results in delays to credentialing and enrollment workflows—both essential for operational efficiency.

Nearly 44% of respondents said their teams are understaffed for their workloads. Surprisingly, this isn’t due to unfilled roles. Many teams are simply being asked to stretch further.

Making matters worse, 38% of enrollment teams report growing financial pressure to reduce headcount, a 13% increase from last year. While cost-cutting efforts are understandable, they risk worsening inefficiencies and overburdening teams already stretched thin.

The door is open for operational efficiencies

Speed—or the lack of it—is another challenge. 49% of respondents said their workflows are “too slow” to “moderately fast.”

The financial strain is particularly pronounced among C-level executives, with 60% saying slow enrollment processes impact their revenue. Provider groups are hit hardest, with 37% of C-level executives there citing revenue losses. These inefficiencies not only affect financial performance but can also lead to delays in provider availability, further compounding the problem.

Perhaps most concerning is the lack of visibility into the full extent of the financial impact. Nearly 47% of organizations reported being unaware of the dollar amount lost due to slow enrollment workflows, specifically. This suggests that the true financial toll of these inefficiencies is likely underestimated.

These findings highlight the need for healthcare organizations to prioritize operational efficiencies. By addressing slow workflows and gaining greater visibility into revenue impacts, organizations can reduce delays, improve financial performance, and ensure providers are able to deliver care without interruption.