Credentialing professionals work in a variety of health-related fields. They are usually in charge of verifying the credentials of employees and service providers. Many people in this position have a variety of other responsibilities as well as experience working in a medical office. Specific certifications and educational requirements are required for some jobs in this field.
A credentialing specialist can work for an insurance company or for a healthcare facility or company, such as a hospital or an ambulatory care facility. This person ensures that his or her employer, as well as all parties or companies with whom the employer works, adhere to all regulatory standards. He or she goes through a rigorous vetting process to verify and process all credentialing information. Calling insurance companies, universities, and certification boards, as well as cross-checking all information against government-regulated databases, could be part of this process. When his or her employer is undergoing its own accreditation process, this position typically works with internal and external auditors.
Creating and maintaining important credentialing reports is one of the other responsibilities of someone in this position. Accreditation, facility privileges, and membership in associations or other groups are usually included in these reports. When gathering data, the specialist must cross-check it against government guidelines and use the information to process credentialing applications. A credentialing specialist working for a hospital, for example, verifies a doctor’s education, certifications, and work history before granting him or her admitting privileges.
A credentialing specialist with a bachelor’s degree or at least a two-year associate’s degree is preferred most employers. Most credentialing positions require candidates to have worked in a medical office or environment in some capacity, in addition to the educational requirements. They must be familiar with industry standards and guidelines for both provider and facility credentials documentation. Basic computer skills and experience with spreadsheet and word processing programs are also common requirements.
After working in the position for at least 12 months, a credentialing specialist can pursue the Certified Provider Credentialing Specialist (CPCS) designation. This certification is required to work as a medical credentialing specialist or in positions that oversee employee certification and licensure. The National Association of Medical Staff Services, American Academy of Professional Coders, Board of Medical Specialty Coding, and Professional Association of Healthcare Coding Specialists all offer certification.