Credentialing Specialist

Job Description

If you are a detail-oriented person who likes working with people, a career as a Credentialing Specialist may be a good fit for you. Credentialing Specialists work with health care organizations. They make sure that doctors and health care facilities comply with relevant standards and regulations.

A Credentialing Specialist prepares and keeps reports of credentialing activities like accreditation, membership, or facility privileges and makes sure the applications meet federal, state, and local guidelines. Health care facilities and insurance groups are a few of the workplaces that need Credentialing Specialists. Credentialing Specialists need to stay on top of any changes to credentialing guidelines and make sure all records and applications are up to date.

Also, Credentialing Specialists often must stay in contact with staff and insurance companies to make sure they have all the documents they need and to let them know about any changes to contracts, guidelines, and policies. Credentialing Specialists should be familiar with word processing and spreadsheet programs, as they are essential to performing the duties of this position.

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 Background

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

Skills and Competencies

• 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

Compensation

According to Payscale the median annual salary of a Credentialing Specialist with

1 year of experience:

• Orlando, Florida: $36,000
• Tampa, Florida: $35,000
• Jacksonville, Florida: $38,000
• Miami, Florida: $37,000
• Atlanta, Georgia: $39,000
• Chicago, Illinois: $42,000
• Houston, Texas: $36,000
• Los Angeles, California: $41,000
• New York, New York: $38,000
• Seattle, Washington: $45,000
• Overall: $38,000

5 years of experience:

• Orlando, Florida: $39,000
• Tampa, Florida: $38,000
• Jacksonville, Florida: $40,000
• Miami, Florida: $40,000
• Atlanta, Georgia: $42,000
• Chicago, Illinois: $44,000
• Houston, Texas: $40,000
• Los Angeles, California: $45,000
• New York, New York: $46,000
• Seattle, Washington: $49,000
• Overall: $42,000

Similar Job Titles

• Credentialing and Concierge Coordinator
• Application Specialist
• Initial Application Specialist
• Credentialing Audit Specialist
• Compliance Specialist
• Privilege Specialist
• Credentialing Coordinator

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.

Position Trends

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.

Job Outlook

According to the U.S. Bureau of Labor Statistics, the Medical Records and Health Information Technician field is expected to grow by 11 percent from 2018 through 2028. That’s much faster than average.

Typical Work Hours

Most Credentialing Specialists work from 9 a.m. to 5 p.m. Monday through Friday. However, some who work in facilities that are open 24 hours a day could work other shifts.

Where You Can Find Jobs

• 4 Corner Resources
• Career Builder
• Glassdoor
• Indeed
• LinkedIn
• Monster 
• Zip Recruiter
• Explore Health Careers

Are You Interested in Becoming a Credentialing Specialist?

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