What Is the Job Description of a Credentialing Specialist?

Credentialing specialists work for healthcare organizations and ensure that physicians and healthcare facilities are in compliance with relevant regulations. Find out about the job duties, education requirements and salary potential for this career. Schools offering College Administration & Leadership degrees can also be found in these popular choices.

What Would I Do as a Credentialing Specialist?

As a credentialing specialist, you work at a healthcare facility, insurance group or similar organization to enforce regulatory compliance and quality assurance. Your job duties include preparing and maintaining reports of credentialing activities such as accreditation, membership or facility privileges. You ensure that all information meets federal and state guidelines when processing applications. For example, if a doctor requests admitting privileges at a hospital, you would process the application to make sure the doctor is eligible; then you would maintain all the records and documentation of the application and verification. You also keep a facility's accreditation up to date and assist auditors.

What Education Do I Need?

Most medical records specialists have an associate's degree, according to the U.S. Bureau of Labor Statistics (www.bls.gov). The Commission on Accreditation for Health Informatics and Information Management accredits degree programs in health information management at the associate's, bachelor's and master's degree levels (www.cahiim.org). In a 2-year associate's degree program, you study medical terminology, healthcare procedures, legal requirements and insurance processing.

What Qualifications Do I Need?

The National Committee for Quality Assurance (NCQA) has developed one of the most commonly used guidelines for health care quality, including the documentation of facility and provider credentials (www.ncqa.org). You should be familiar with NCQA standards and how to apply them. You should also be proficient with computer systems, networks and software applications, such as word processors and spreadsheets. After gaining some experience in the field, you may choose to pursue the Certified Provider Credentialing Specialist professional designation from the National Association of Medical Staff Services (www.namss.org). You are eligible to take the certification exam after you have three years of experience, including during the year prior to taking the exam.

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