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Get to know about the duties, responsibilities, qualifications, and skills requirements of a credentialing specialist. You can use our job description template in this article to produce your own. We also provide you with information about the salary you can earn as a credentialing specialist.

 

Who is a Credentialing Specialist?

A Credentialing Specialist is an individual who makes sure that medical staff members have up-to-date credentials and licenses so they can legally practice in their field or specialization. Credentialing specialists often work for healthcare organizations to ensure that the hospitals and doctors’ offices abide by given standards. These specialists regularly monitor when licenses need to be renewed and collaborate with the medical team to inform them of what has to be done. Before hiring, credentialing specialists check the information on possible new hires to ensure that they have all the necessary licenses and qualifications.

A credentialing specialist’s job is essential because they make sure that medical institutions and doctors adhere to federal and state regulations and that they have the appropriate licenses. They also keep track of the medical staff’s training and certifications. Specialists in credentialing ensure that doctors and medical facilities conform to applicable laws when working for healthcare companies. They might also maintain records of employee credentials and insurance contracts. They frequently need to stay in touch with employees and insurance providers to make sure they have all the appropriate paperwork and to let them know if there have been any changes to contracts or policies. Credentialing specialists must be proficient with a range of programs, including word processing and spreadsheet tools, as a large portion of their job is done on computers.

Specialists in credentialing verify the credentials of medical workers in healthcare facilities. The credentialing specialist makes sure that the hospital or healthcare facility abides by federal and state laws governing the certification and licensure of medical personnel. The credentialing specialist serves as a point of contact between the hospital’s management and the medical team, which includes doctors, technicians, and nurses. Credentialing specialists keep track of the expiration of certifications and licenses as well as the data for all of the facility’s providers.

Additionally, these specialists make sure that healthcare professionals promptly update their qualifications or licensure. New applications for physician privileges at the facility are also processed by the credentialing specialists. A credentialing specialist should have a bachelor’s degree or at least a two-year associate’s degree, as recommended by the majority of companies. Most credentialing roles demand candidates to have experience working in a medical office or environment in some capacity in addition to the educational requirements. They must be knowledgeable about the requirements and best practices in the industry for submitting provider and facility credentials. Basic computer literacy and practical expertise using word- and spreadsheet-processing software are two more typical requirements. To oversee and keep track of the qualifications of the medical personnel in a healthcare facility, credentialing specialists need to be very organized. To write letters and emails to service providers and administrators inside the company, the position also needs strong written communications skills. While carrying out their duties, credentialing specialists must be able to work independently, analyze data, and conduct research.

 

Credentialing Specialist Job Description

Below are the credentialing specialist job description examples you can use to develop your resume or write a job description for your employee. Employers can also use it to sieve out job seekers when choosing candidates for interviews.

The duties and responsibilities of a credentialing specialist include functions such as the following:

• Provide credentialing policies and procedures recommendations to ensure adherence to legal requirements and industry best practices.
• Work with other organizational departments to make sure that credentialing efforts are in line with business objectives.
• Investigate candidates’ prior education, experience, and training to see if they qualify for a certain certificate.
• Examine applications and give tests to gauge a candidate’s understanding of industry standards
• Provide direction on the credentialing procedure and respond to inquiries from applicants regarding their applications.
• Work with potential employers to ascertain whether applicants satisfy the criteria for employment in the industry.
• Examine resumes, transcripts, and letters of recommendation to ascertain a candidate’s suitability for a position.
• Follow up with candidates who have not complied with requests for information or payments to make sure that they are moving toward receiving their certification.
• Create official documentation attesting to the credential’s holder, such as a doctor or lawyer.
• Process applications for initial and renewed credentials.
• Operate as the main point of contact for any enquiries regarding credentials and re-credentialing
• Keep your understanding of NCQA, URAC, and other accrediting standards up to date.
• Keep accurate records of all medical staff members’ qualifications.
• Ask staff members for new credentials and gather them
• Check that the credentials are current and genuine.
• Perform background checks on new hires
• Make sure that every employee satisfies the prerequisites for their employment.
• Observe the dates that certificates and licenses expire
• Make arrangements with staff members to make sure they possess the qualifications required for their positions.
• Assist new hires with the onboarding procedure.
• Respond to staff members’ inquiries concerning certification criteria.
• Oversee and control the entire provider enrollment procedure.
• Gather, examine, and confirm the accuracy and completeness of the provider applications and accompanying documents.
• Verify the provider’s credentials through main sources by set policies.
• Create and send payors accurate and comprehensive applications.
• Track the status of applications with payors and follow up as necessary.
• Inform providers of credentialing decisions fastly.
• Observe changes in the demographics of providers and update the provider database as necessary.
• Produce various reports about provider credentialing activities as needed.
• Participate in departmental efforts to enhance quality.
• Examine the practitioner’s application and other supporting materials to determine eligibility.
• Generate information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other relevant sources.
• Discover informational inconsistencies and follow them up.
• Present applications to the Credentialing Committee of the facility.
• Assist clients with inquiries about credentials.
• Answer questions from health plan providers.
• Archive primary source data in digital databases.
• Ensure the backup of data.
• Endure adherence to all relevant laws, rules, guidelines, and policies.

 

Qualifications

• GED, high school diploma, or any suitable equivalent.
• A minimum of 2 years of credentialing experience with hospital medical staff.
• Must be a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS).
• Knowledge of medical credentialing procedures.
• Understanding of medical privileging standards.
• Excellent communication skills both in verbal and written form.
• Proficiency in Microsoft Office Word and Excel.
• Touch-typing skills expertise.
• Ability to focus for extended periods.

 

Essential Skills

• Communication skills: Communication skill is essential because the interaction between credentialing specialists, coworkers, candidates, and clients is common. Credentialing specialists regularly communicate verbally to clarify procedures and respond to inquiries. As they may send emails to coworkers or applicants and create letters to clients, written communication is equally crucial. You may explain the credentialing procedure to both students and businesses by using clear communication. You can effectively discuss ideas and work on projects with others thanks to it as well.
• Organizational skills: Credentialing specialists typically work with many files and documents simultaneously. They might have to maintain track of data about employees, training logs, licenses, and other things. You might need to keep records for each client or employer you work with as a credentialing specialist. Making sure you have all the required documents and forms on hand when needed can be made easier by having great organizing abilities. Being organized in your personal life can help you manage your time effectively and remember any deadlines. You might need to keep track of a variety of documents, information, and data relevant to the creation of credentials. Strong organizational skills can help them remain on top of all the tasks associated with this work and keep track of the information they need to execute their jobs, allowing them to give clients high-quality service.
• Technological skills: Credentialing specialists use technology to connect with others, create and deliver documents, and access and update information. They might employ technology to do research and create fresh protocols. Understanding how to use different software packages is essential for this position.
• Attention to detail and analytical skills: Your ability to pay attention to detail will help you execute your task effectively. It’s essential to be attentive when analyzing documents or applications since as a credentialing specialist, you might need to analyze and approve a lot of material. Before approving an applicant’s application, you might also need to make sure that the information in their file is accurate. The ability to analyze data and information, spot patterns and trends, and draw conclusions from those findings are known as analytical skills. When reviewing applications for credentials, assessing a trainee’s performance in training sessions, and determining if a candidate has satisfied all certification requirements, credentialing professionals apply their analytical skills.
• Research skills: Research skills are essential because credentialing specialists often investigate the requirements for various credentials. They might research the requirements for a certain certificate, like one for a medical assistant, or they might research the requirements for a particular industry, like healthcare. They might also look into the qualifications needed for a certain job, like a medical assistant in a hospital.
• Customer service skills: You may engage with customers and give them the information they need to make an informed decision by using your customer service skills. Specialists in credentialing usually assist clients in understanding the process of obtaining credentials and the prerequisites for each certificate. You might use your customer service abilities to assist them in appreciating the worth of the credential and its advantages.
• Knowledge of medical terminology: The language used by medical professionals to explain bodily functions, diseases, and treatments is known as medical terminology. To effectively assess credentials and comprehend the information provided by applicants, credentialing professionals must have a clear understanding of medical terminology. When discussing patient records or treatment plans with other medical experts, medical terminology also facilitates communication.

 

How to Become a Credentialing Specialist

Step 1. Obtain relevant education

A bachelor’s degree in business administration or a closely related discipline is required for the position of credentialing specialist. A degree is required in a related discipline, such as health care administration, health information technology, or health care management, and is usually preferred by employers of credentialing specialists. When pursuing this professional field, coursework in organizational management and human resources can be beneficial. Consider joining the National Association of Healthcare Credentialing Consultants (NAHCC) while pursuing your degree to learn more about the healthcare sector. Having a master’s degree in health administration or health care management is required by some large corporations for credentialing specialists.

Step 2. Acquire work experience

Before working as a credentialing coordinator, it is beneficial to obtain medical experience. This will make it easier for you to understand the regular duties of the healthcare professionals you’ll be working with and educate yourself on the procedures needed to obtain credentials. Try to collaborate directly with the kinds of professionals you’ll be credentialing, if at all possible. Consider working as an office assistant or nurse aide at a doctor’s office if, for instance, you want to become a coordinator for doctor credentialing. Consider working as a nursing assistant or volunteering at a hospital if you want to become credentialed as a nurse. When they begin new employment, credentialing experts typically undergo on-the-job training. This training may involve working as a senior credentialing specialist’s assistant or shadowing an experienced credentialing specialist.

Step 3. Join a professional association

Become a member of a professional organization such as the National Association of Medical Staff Services (NAMSS). Professionals in medical staff services have access to networking and training opportunities through the NAMSS. You may network with other professionals in related fields and remain up to date on credentialing developments in the healthcare sector by becoming a member of NAMSS. It’s also advantageous to join your local organization of the American Health Information Management Association (AHIMA) if you want to work as a credentialing coordinator. The members of this association have access to a wide range of resources and advantages.

Step 4. Acquire certification and licensure

Through a variety of online courses, credentialing professionals can get certificates to increase their theoretical knowledge. These professionals can also pursue certifications to learn the skills they need in the practical world to do their jobs well. The National Association of Medical Staff Services (NAMSS) grants the CPCS (Certificate of Practicing Credentialing Specialists) certificate, which attests to your proficiency in provider credentialing. You must pass several courses on subjects like medical staff management, risk management, and credentials to obtain this certification. You may also need to submit an application and supply supporting materials. Numerous other certificates are available from the NAMSS that can help you develop in your role as a credentialing coordinator. These include the Certified Credentialing Manager (CCM), which emphasizes leadership abilities, and the Certified Credentialing Specialist (CCS), which requires you to pass an exam covering fundamental ideas of credentialing.

 

Where to Work as a Credentialing Specialist

Credentialing specialists are employed in a variety of health-related industries, insurance groups, medical facilities, ambulatory care companies, clinics, and physician offices. They usually work full-time, and some of them may work evenings or weekends to meet deadlines, keep up with the demands of the job, and complete tasks. Credentialing specialists must be able to work with a team and also independently as the case may be.

 

Credentialing Specialist Salary Scale

The salary scale of a credentialing specialist varies depending on some factors such as level of education, years of experience, company size, and geographic location. They may also earn extra pay in the form of bonuses or allowances. The average salary of a credentialing specialist in the United States is $43,185, but the range typically falls between $38,793 and $48,785 per year. In the UK, the average salary credentialing specialists earn is $46,700, and between $41,900 and $52,700 is the range salary. The base salary for credentialing specialists ranges from $36,996 to $46,528 with an average base salary of $41,189 per year. A person working as a credentialing specialist in Nigeria typically earns around 3,320,000 NGN per year. The salary range is from 1,735,000 NGN to 5,550,000 NGN per year.

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