Credentialing SpecialistJob Description, Salary, Career Path, and Trends

Credentialing specialists typically work for healthcare organizations and ensure that the physicians and healthcare facilities comply with regulations. They must have good communication skills as they often have to stay in contact with insurance companies regarding changes in contracts and policies. Credentialing specialists need to be proficient with a variety of relevant computer programs and have excellent attention to detail. As this role includes the preparation and maintenance of reports pertaining to such credentialing activities as accreditation, membership, or facility privileges, solid written communication skills are required. 

The role of a credentialing specialist is an important one as they ensure that healthcare facilities and physicians are following federal and state guidelines and that medical doctors and nurses have the necessary licenses they need. They also maintain records of training and certifications for the medical staff. Credentialing specialists must be familiar with medical terminology, have solid research skills, and have exceptional organizational skills.

Sample job description

New credentialing specialist needed at [Your Company Name] to oversee and verify credentials of local medical professionals. The credentialing specialist will be required to keep up to date with the latest state, local, and national policies and credentials. You must track medical professionals to ensure proper training, certifications, and experience. Your job responsibilities will include managing databases with information pertinent to this position as well as verifying the liability and eligibility of doctors in the facility. You must be competent with the latest procedures and medical policies in order to ensure facilities and professionals are properly credentialed and following accurate procedures. If chosen, you will work at [Your Company Name] full-time and have access to benefits. If you have a fantastic understanding of the latest medical policies, previous experience in this field, a strong work ethic, and the ability to properly record and supplement data, this position will be for you! Please consider applying. [Your Company Name] would love to have you on our team.

Typical duties and responsibilities

  • Process initial credentialing and re-credentialing applications
  • Screen practitioners’ applications and supporting documentation to ascertain their eligibility
  • Present applications to the facility’s Credentialing Committee
  • Assist customers with credentialing inquiries
  • Reliably back up data
  • Capture primary source documentation in computer databases
  • Ensure compliance with applicable laws, regulations, procedures, and policies

Education and experience

This position requires a high school diploma or equivalent. 1+ years of credentialing experience with a hospital medical staff is preferred.

Required skills and qualifications

  • Knowledge of medical credentialing and privileging procedures and standards
  • Excellent verbal and written communication skills
  • Proficient in Microsoft Office Word and Excel
  • Ability to focus for extended periods
  • Proficient in touch-typing

Preferred qualifications

  • Bachelors degree preferred
  • Healthcare experience
  • Excellent written and oral communication skills
  • Computer literate with proficiency in web-based products and ability to learn new applications easily
  • Attention to detail and accuracy
  • Professional friendliness

Average salary and compensation

The average salary for a credentialing specialist is $44,500 in the United States. Position salary will vary based on experience, education, company size, industry, and market.

LocationSalary LowSalary High
Phoenix, Arizona$44,250$59,850
Los Angeles, California$49,950$67,550
Denver, Colorado$41,600$56,250
Washington, DC$50,650$68,550
Miami, Florida$41,450$56,050
Orlando, Florida$38,200$51,650
Tampa, Florida$38,550$52,150
Atlanta, Georgia$40,450$54,750
Chicago, Illinois$46,500$62,950
Boston, Massachusetts$50,300$68,050
Minneapolis-St. Paul, Minnesota$40,050$54,250
New York City, New York$52,950$71,650
Philadelphia, Pennsylvania$43,150$58,350
Dallas, Texas$41,950$56,800
Houston, Texas$41,750$56,550
Seattle, Washington$48,400$65,500
National Average$37,850$51,150

Typical work environment

A credentialing specialist will be tasked with ensuring that healthcare facilities and professionals are following the proper regulations and policies and are credentialed properly. These professionals must have excellent interpersonal skills and an excellent understanding of the latest state and national medical policies. A good understanding of various computer programs and basic computer troubleshooting may be beneficial, as the majority of work done by credentialing specialists is through the computer. These specialists will be tasked with keeping records of the latest insurance, credentials, and certifications, and updating specialists when there are any notable changes in policies or regulations. Ideally, credentialing specialists must understand various aspects of the medical field and be able to keep up to date with information accurately and efficiently. This position often will be in an office or clinic environment. The position will likely be full-time.

Typical hours

Most credentialing specialists work from 9 AM to 5 PM, Monday through Friday. However, some who work in facilities that are open 24 hours a day could work other shifts.

Available certifications

A credentialing specialist can have certificates that will prove useful to their field. Some of the relevant certificates to this position may be:

  • Credentialing Specialist (CPCS) Online Certification Preparation Course. The credentialing specialist online certification preparation course is a course designed to prepare a credentialing specialist for the assessment test for the CPCS certification. This test is uniquely beneficial to credentialing specialists who are looking to expand their certifications and expertise in the field.
  • Certified Provider Credentialing Specialist (CPCS). The preparation course is a predecessor to the certified provider credentialing specialist course, which is a uniquely challenging course that may vary depending on the location and proper policies this certification is required to cover. This certification is offered by the NAMSS and is widely recognized as the leading certification for a credentialing specialist.

Career path

Credentialing specialists can often find work with a high school diploma or the equivalent. Candidates who have associate, bachelor’s or master’s degrees in a field like health information management are often more attractive to employers looking to fill credentialing specialist positions. Students are encouraged to take courses in subjects like medical terminology, health care procedures, legal requirements, and insurance processing while they are in school.

After three years in the field, credentialing specialists can apply for certification from the National Association of Medical Staff Services. The skills used and learned in the credentialing specialist field can also be applied to other careers like human resources, insurance underwriting, and community service management.

US, Bureau of Labor Statistics’ job outlook

SOC Code: 29-9098

2020 Employment81,400
Projected Employment in 203089,900
Projected 2020-2030 Percentage Shift 11% increase
Projected 2020-2030 Numeric Shift8,600 increase

According to the National Association of Medical Staff Services, credentialing specialists and other medical staff professionals should be aware of and ready to adapt to the increasing digitization of their field. More credential application programs and databases are being moved online and into the cloud, and the ability to work with those systems will be essential for credentialing specialists in the years to come.

Also, many health care companies are consolidating facilities, which is leading to all health care staff workers taking on a wider array of responsibilities. Another trend credentialing specialists should stay on top of is the increased use of telemedicine. More health care providers are seeing patients remotely, and that could change insurance and accreditation guidelines.

Sample interview questions

  • What do you know about credentialing?
  • Are you confident in your ability to accurately assess and understand policies and procedures?
  • How many years of experience do you have as a credentialing specialist?
  • Do you have any relevant certifications for this position?
  • How would you resolve a change in policy and successfully update the relevant medical professionals?
  • What makes you think you’re a good fit for our company?
  • How important is it to keep the information confidential?
  • Are you skilled with computers?
  • Do you have knowledge of any medical software?

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