From spreadsheets to SaaS: Redesigning how Medical credentialing works
SaaS Platform
B2B
US Healthcare
About BilliMD
BilliMD is a US healthcare credentialing company that helps medical providers (doctors) get verified by insurance companies; a mandatory process before any doctor can legally practice or receive insurance reimbursements.
Before this project, the entire process was handled manually. Sales Representative (Patricia) guided providers through insurance selection over the phone. Credentialing Specialist (Golla) chased documents, verified licenses, and tracked everything through spreadsheets and back-and-forth emails. It worked but it didn't scale.
I joined as a Product Designer to help build BilliMD's first ever digital product from scratch along with another designer and the product team.
Team:
2 Designers · 4 Frontend Engineers · 3 Backend Engineers · 1 QA · 1 Product Owner
My Contribution:
Led UX research and ideation, Co-designed features of the credentialing platform,
Timeline:
Aug 2024 - July 2025
Overview
What is Medical Credentialing?
Medical credentialing is the mandatory process every healthcare provider must complete before they can legally practice or receive insurance reimbursements. It verifies a provider's qualifications, licenses, certifications, and background against national standards primarily through CAQH ProView, the centralized database used by US insurers. Without it, a doctor cannot see insured patients or get paid by insurance companies.
The process spans 7+ stages, involves dozens of documents, and typically takes 3 to 6 months to complete. For most providers, it's the single most painful administrative burden in their career and for clinics managing multiple providers, it's an operational nightmare.
Why Credentialing matters:
For Medical Providers
Without credentialing, doctors can’t bill insurers, see insured patients, or appear in directories, making it the first step for any new or relocating provider.
For Clinics
Clinic revenue depends on credentialing, uncredentialed providers delay billing, cause claim rejections, and put revenue on hold for multi-provider clinics.
For Insurers
Insurance companies require credentialing to verify a providers’ qualifications, licenses, malpractice coverage, and disciplinary history.
Challenge
Credentialing is slow, opaque, and a complex process
Design Problem Statement
How might we digitize the credentialing process so providers can independently track and manage their journey while enabling BilliMD to serve more clients without proportionally growing headcount?
Business Growth Challenge
Every new client increased Patricia and Golla’s personal workload. Onboarding, tracking, and communication were handled manually, making growth directly dependent on hiring more people. The process had hit a scalability ceiling.
Product Complexity Challenge
Credentialing involved CAQH compliance, multi-state insurance enrollments, identity verification, document management, and multi-stakeholder workflows. The challenge was simplifying this complexity into a structured and intuitive product.
Research & Discovery
Understanding the landscape
Our research was primarily internal, we worked closely with the people who knew this world best: Patricia, Golla, our in-house doctors, the product owner, and a focused user group of medical providers we tested each iteration with before broader rollout.
These sessions, combined with desk research into CAQH provider standards, healthcare UX conventions, and competitive analysis of MedTrainer and Modio Health, formed the foundation of every design decision. Every direction was pressure-tested before engineering picked it up.
Research & Testing Methods:
Stakeholder sessions with Patricia, Golla, in-house doctors, and the product owner
Desk research on CAQH ProView standards, healthcare UX conventions, compliance requirements
Competitive analysis of MedTrainer and Modio Health (our main competitors); powerful for large enterprises, but too complex for smaller practices
Focused iterative sessions with a core group of medical providers after each build cycle
Stakeholder decks to communicate design decisions and gather valuable feedback.
Key Pain Points
Credentialists and sales representatives spent hours: chasing the same documents repeatedly with multiple rounds of validation and errors due to slow communication.
Providers weren’t frustrated by credentialing itself: but by not knowing what comes next, where they are in the current process and how much more time it will take to get credentialed.
Clinics lacked visibility and accountability: across multiple provider accounts further complicating their work.
Valuable Input I got from Golla and Patricia:
Credentialists spent most of their time on repetitive administrative follow-ups that added no clinical value
Clinics managing multiple providers had no unified visibility across their team's credential statuses
Providers routinely needed hand-holding — the process felt opaque and stressful, especially for smaller practices
Existing users valued the human relationship with BilliMD — the platform needed to preserve that trust
What we found about our competitors
Both MedTrainer and Modio Health cater primarily to large enterprise healthcare systems. Their platforms are powerful but carry a steep learning curve — too complex and overwhelming for individual practitioners and smaller practices.
The gap was clear: no solution existed that balanced the depth of a full credentialing platform with the simplicity that smaller providers actually needed.
User Personas
Working with stakeholders, we identified three distinct user types the platform needed to serve, each with fundamentally different goals and mental models.
Guiding Principle
Before any wireframe was drawn, we defined the principles that would keep every decision grounded especially when navigating between user pain points and BilliMD's values.
Guidance, not bureaucracy
Break CAQH's 7+ stages into what's needed right now not the full weight of the process at once.
Transparency at every step
A provider shouldn't have to call BilliMD to find out where their application stands.
Automate the chase
Reminders, expiry alerts, and missing document flags should be handled by the system.
Consider practice sizes
A solo physician and a clinic admin managing 15 providers shouldn't feel like they're using different tools.
No silent failures
Rejected documents could sit unnoticed for days. Every update needed to surface instantly with clear next steps, not just a label.
Trust through verification
Medical licenses, DEA certificates, identity documents. Every touchpoint should handle sensitive data in a secured way.
The Detour
We started with
the wrong first step
The first product we built wasn't the credentialing platform. It was a Custom Pricing Portal (CPP), a self-checkout tool that let healthcare providers independently browse insurance plans, configure their practice details, get a custom price quote, and check out all without talking to a sales rep.
The idea was logical: if we could automate the front-end insurance selection process (Patricia's job), we'd free up BilliMD's sales team and give providers more control. We designed it fully, built it, and launched it to a focused group of real users.
What the CPP did:
Allowed providers to select their practice details: size, location, specialty to get relevant plan options
Surfaced tailored insurance plan recommendations across HMO, PPO, Medicare/Medicaid, and more
Generated a custom price quote based on number of providers and practice locations
Completed with checkout and DocuSign agreement: end-to-end, no human required
Step 1
Custom Plan Builder
Provider selects practice type, size, and states of operation.
Step 2
Insurance Selection
Browse from 1,500+ insurance plans relevant to their practice.
Step 3
Plan Selection
Choose from 4 support plan tiers: Monitor Plus, Basic, Pro, or Elite.
Step 4
Basic Info
Provide contact and billing information for account creation.
Step 5
Custom Quote
Review a personalized price breakdown based on all selections.
Step 6
Payment
Complete purchase through secure checkout.
Step 7
DocuSign
Sign the Master Service Agreement — account activated.
The Pivot
The platform was built. Users had access. It didn't stick.
After launching to our focused user group, the feedback came back clearly — and it wasn't about the design. Insurance selection isn't where the credentialing journey starts. Our users were already familiar with the physical, relationship-based process of choosing a plan through Patricia. They trusted it, they understood it, and automating it didn't solve a pain they actually felt. The CPP solved a business efficiency problem, not a user problem.
The product owner and our focused user group made it clear: the credentialing platform itself — the document management, tracking, and verification — was the real problem to solve first. Insurance selection would eventually be integrated there, not live as a standalone product.
What the CPP taught us
The CPP wasn't a failure: it was the most important alignment exercise we ran. Going through the full design and build cycle revealed exactly what our users valued and what they found disruptive.
It also gave us a clear mental model for insurance selection that we later integrated directly into the credentialing platform. So the learning wasn't lost, it was absorbed.
Don't automate what users aren't asking to do themselves. The gap was credentialing visibility, not purchasing.
Test sequencing, not just features. The CPP flow worked launching it before a credentialing home didn't.
Stakeholder feedback loops are essential. Our focused user group saved us from doubling down on the wrong product.
Designing the Credentialing Platform
Building the credentialing
platform from zero
With the CPP learnings in hand, we redirected to what users actually needed; a place to manage their entire credentialing journey end-to-end. I led the research and ideation, and co-designed every feature of the platform. Every decision was continuously tested with our focused user group through stakeholder presentations and live product sessions before being handed to engineering.
Goals & Resources
6+
Core platform modules to be designed end-to-end from scratch
60↓
Reduce the new user onboarding time from a 60-minute process
3+
Users served: individual providers, clinic admins, BilliMD team
11
People across design, engineering, QA, and product working in sync
Information Architecture
Credentialing involves multiple interconnected steps; forms, documents, verifications, status tracking. I mapped these complex backend operations into a modular structure that reflects how users naturally progress, rather than how the system processes data behind the scenes.
Deciding what to build
Every feature went through the same filter: does this solve a real user problem, does it serve BilliMD's business goals, and can we actually build it within our MVP scope?
Four Roles. One Platform.
One of the core design challenges was building a single platform that could serve fundamentally different users without creating confusion. Each role sees a tailored experience.
Admin
BilliMD Internal Team
Credentialists who review provider progress, assign documents, leave comments, send custom notifications, and flag issues on the platform.
Super User
Organization Owner
Purchases and manages the BilliMD plan. Controls user access, tracks enrollment statuses across all providers under their account, and interfaces with BilliMD's team.
User
Individual Healthcare Provider
Fills out their credentialing information, uploads documents, tracks personal progress, and completes identity verification. The core user of the platform.
Managing Account
Delegated Access to an assistant
A user given access to manage another provider's account on their behalf with full platform access except account settings, enabling practices to delegate administrative work.
Final Design
The Medical Credentialing platform
A single, unified platform that turns what was once a phone-and-spreadsheet operation into a transparent, trackable, and automated credentialing experience.
Feature 01
Home Dashboard
Gives providers a real-time overview of their credentialing progress, pending actions, and active alerts, turning what was previously opaque into something clear and motivating.
Progress is visible. Actions are obvious. Nothing is buried.
Feature 02
Information Selection
Credentialing forms are notoriously long and complex. CAQH ProView alone spans dozens of sections across personal info, specialties, practice locations, hospital affiliations, disclosures, and more.
The Information feature breaks this into structured, digestible steps with the option to import directly from CAQH, auto-filling large sections of the form. Each section is validated in context so errors are caught early, not at submission.
Feature 03
Insurance Selection
Providers can browse 1,500+ insurance plans, select enrollments, and track their processing status. A queue system show which month each insurance is being processed, and real-time visibility on blocked, in-progress, and completed enrollments.
What once took a 30-minute call with Patricia now takes under 5 minutes.
Feature 04
Documents
The documents feature consolidates everything into a structured, status-driven table: Requested, Pending, Approved, Rejected.
Providers upload once, see exactly what's needed, and get notified when something expires or needs attention. Admins can assign document requirements and review uploads without leaving the platform.
Version 1: Not continued due less modern and disorganized in terms of information.
Version 2: Another iteration
Feature 05
Admin View
Admins can select individual client accounts, review their credentialing progress, assign documents, leave comments on specific sections, send custom notifications, and flag accounts for review.
Everything Golla did via email and spreadsheets now lives in one place.
Impact & Outcomes
Delivering real value for users and business
60→15
Minutes for provider onboarding, a 4 times reduction in time to start credentialing
∞
Scalability: BilliMD can now handle significantly more clients with the same internal team.
30→5
Minutes for insurance selection replaces a full sales call with a self-serve flow
0→1
With the platform, BilliMD went from a service business to a software business.
Reflection
What I'd take forward
One of the core design challenges was building a single platform that could serve fundamentally different users without creating confusion. Each role sees a tailored experience.
Lesson 01
Stakeholder testing is real research
Our focused user group of medical providers, tested iteratively after each build, gave us feedback that no desk research could have. The CPP pivot came from them, not from us. Building that loop early saved months of work.
Lesson 02
Complexity demands collaboration
Designing a healthcare platform from scratch with multi-stakeholder workflows, and zero legacy code, required constant alignment with engineering, the product owner, and QA. Weekly syncs and stakeholder decks were non-negotiable.
Lesson 03
Designing from scratch is hard. Designing from scratch in healthcare is harder.
Every decision had downstream consequences: on compliance, on trust, on the real people trying to practice medicine. That weight made this project the most challenging as well as interesting
