How to Become a Medical Credentialing Specialist

By Robert Half September 22, 2017 at 9:49am

Healthcare is hiring. If your skill set includes outstanding communication skills and an exceptional eye for detail, combined with an interest in medical terminology, you could have a rewarding career as a medical credentialing specialist.

As a result of the 2010 Affordable Care Act (ACA), the number of people in the U.S. with health insurance has increased. As more people enter the healthcare system, payers and providers have to keep up with the growing workload. In addition to needing more medical practitioners, there’s a demand for skilled administrative staff.

Regardless of what happens with the ACA in the future, healthcare will remain a hot field for medical administrative specialists.

What does a medical credentialing specialist do?

Medical credentialists are employed by healthcare organizations such as hospitals, group practices and ambulatory care service providers, as well as credentialing agencies. These administrative specialists’ job is to verify that the professional training, certifications and licensing of healthcare professionals, which need to be renewed periodically, are up to date and in compliance with state and federal regulations. Credentialing specialists also ensure that any services provided by medical facilities meet the required standards as set by state and federal government agencies.

What are the day-to-day responsibilities?

Medical credentialing involves maintaining databases for medical professionals and healthcare facilities. The primary responsibilities of a medical credentialing specialist include processing paperwork relating to re-credentialing and ensuring databases detailing the practitioners’ education, training, licensing, experience and other information are up to date.

As part of verifying personnel credentials, these specialists do background checks, contact licensing boards, review license applications, request education details and interview references. They may also assist with hiring new staff by reviewing job applications and resumes to ensure that applicants fulfill all necessary licensing and credential requirements — both for the role and the specific healthcare industry.

The process of assessing healthcare facility practices might require credentialing specialists to review the ways in which services are executed. This is to ascertain that the facility is operating within stipulated state and federal regulations.

What do employers look for when hiring credentialing specialists?

Managers want candidates with at least an associate’s degree in healthcare or business administration or equivalent education. Alternatively, applicants could have just a high school diploma plus experience with working in a medical office, preferably as a medical administrative assistant or in a credentialing capacity. For management roles, employers prefer candidates with a bachelor’s degree.

Although not a requirement for all medical credentialing positions, a certification issued by the National Association Medical Staff Services will help applicants stand out from among the competition. NAMSS offers two levels of certifications: the Certified Provider Credentialing Specialist (CPCS) and the more advanced Certified Professional Medical Services Management (CPMSM). Both show that holders are experts in their field and have a mastery of relevant regulations, policies and best practices. Note that applicants for a CPCS need to be currently employed in the medical service professions for at least the past 12 months, in addition to having a minimum of three years of relevant experience within the past five years.

Computer skills are another requirement. Top candidates in the medical credentialing field are proficient in Microsoft Word and Excel, and they have experience working with database management systems. The ability to type and enter data quickly, at a rate of around 50 words per minute, is also highly desirable.

Are soft skills important?

Absolutely. Credentialing specialists need to be highly organized and have meticulous attention to detail. These professionals are responsible for the accuracy and completeness of medical facilities’ records. If they make mistakes, insurance companies may withhold payment or practitioners may lose their admitting privilege to hospitals.

But medical credentialing specialists do much more than just update databases, write reports and submit paperwork. They also spend significant portions of their time communicating with healthcare staff, medical practitioners, fellow healthcare administrators, institutions of higher education and government officials. Therefore, excellent verbal and written communication skills are crucial.

Equally important is emotional intelligence. A medical credentialing specialist interacts with a wide range of personalities and professions, from first-year technicians to a hospital’s chief of staff. The ability to control one’s own emotions, understand people’s motivations and deal with others diplomatically are key attributes every credentialing specialist should have.

And because these professionals work with large amounts of data, employers look for candidates who are cool under pressure, work with little supervision and can juggle multiple deadlines. Credentialing specialists must also respect the sensitive nature of their role, as they handle confidential data such as practitioners’ health status, malpractice and claims history, and criminal background information.

How much does a medical credentialing specialist make?

According to the 2019 OfficeTeam Salary Guide, the salary midpoint for credentialing specialists in administrative healthcare is $38,000. At the midpoint, candidates have average experience with the necessary skills to meet the job requirements, and the role may be in an industry where competition for talent is moderate.

Those with a NAMSS certification or leadership experience can expect higher pay. Use our Salary Calculator to customize the compensation for your city.

This post has been updated to reflect more current information.

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