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How to Become a Certified Medical Credentialing Specialist

Research the requirements to become a certified medical credentialing specialist. Learn about the job description and duties and read the step-by-step process to start a career in medical credentialing.

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Do I Want to Be a Certified Medical Credentialing Specialist?

Medical credentialing specialists work in a variety of healthcare settings, including hospitals, ambulatory care facilities, insurance companies, and credential verification organizations. They typically perform activities associated with maintaining the credentials of medical providers within the organization. Duties may include updating files, assisting with the credentialing or re-credentialing process for members of the medical staff, verifying credentials, and completing clerical duties as needed.

Most medical credentialing specialists work on a full-time basis during business hours. They work in office settings within the healthcare field, spending little time on the move or on their feet. The risk of illness is small but present for those who work in proximity to sick patients.

Job Requirements

Certification is voluntary; however, it may increase the credentialing specialist's chances for professional advancement, earning potential and job opportunities. Organizations like the National Association of Medical Staff Services (NAMSS) issue credentialing specialist certifications. A formal degree is not required, although many employers prefer hiring candidates with at least an associate's degree. The following table lists the core requirements for certified medical credentialing specialists:

Common Requirements
Degree Level High school diploma at minimum; many employers prefer candidates with an associate's degree*
Degree Field Healthcare or a related field*
Experience At least 12 consecutive months of experience needed prior to certification**
Certification Voluntary certification may increase job opportunities and offer job advancement**
Key Skills Ability to multi-task and work in a fast-paced environment, strong written and verbal communication skills, attention to detail, analytical and research skills, ability to work independently*
Technical Skills Knowledge of the credentialing process and familiarity with medical terminology helpful*

Sources: *Online job postings (December 2012), **National Association of Medical Staff Services

Step 1: Obtain a Degree

Although having a degree is not a prerequisite for becoming certified as a medical credentialing specialist, many employers look for candidates with at least an associate's degree. Some options include an associate's program in healthcare administration or health information. The benefit of completing a degree program includes gaining the advanced skills and knowledge necessary for a successful career in the healthcare field. Coursework commonly includes medical terminology, information technology, medical coding and healthcare management.

Step 2: Gain Experience

After completing a degree program, gaining practical experience is a vital step to fulfilling the prerequisites for taking the certification exam. To be eligible to take the certification exam, an individual must have at least 12 consecutive months of experience working in a medical services environment. To gain an entry-level job, candidates usually need to have at least a high school diploma or GED. Employers increasingly prefer candidates with at least an associate's degree and/or some experience working in a related field, such as medical reception, billing or staffing services.

Step 3: Determine Eligibility and Apply to Take the Exam

Eligible applicants for the Certified Provider Credentialing Specialist (CPCS) exam must either be a Certified Professional in Medical Services Management (CPMSM) in good standing and be employed for the past year in medical services, or be currently employed in medical services for at least a year with three years of experience within the past five years. To be eligible for the CPMSM exam, an individual must be a CPCS who has worked for the past year in medical services or has been employed for the past year in medical services with a total of five years of medical services experience within the past eight years.

Individuals can access the application for either exam on the NAMSS website. It must be completed and mailed with the application fee to NAMSS. After the application is approved, applicants will receive a notice to schedule the exam appointment.

Success Tip:

  • Schedule the exam appointment as soon as possible. Appointment times and locations are offered on a first-come, first-served basis. If the location and time that an individual wants is not available, another time and place must be chosen. NAMSS sends everyone a confirmation of the time and date for the exam within three business days of scheduling the exam appointment.
  • Prepare to take the exam. NAMSS offers a preparation course to get candidates ready for the exam. Preparatory courses are helpful to give individuals the knowledge and skills to successfully pass the exam and earn the certification. The prep course covers topics such as credentialing standards, regulation, credentialing application and approval processes, the privileging process and potential licensing challenges.

Step 4: Take the Certification Exam

To be admitted to the test, individuals must bring the confirmation email and photo identification to give to the testing proctor. The test is computer-based and includes a 15-minute tutorial to allow individuals to become familiar with the testing software. Test-takers have three hours to complete the CPCS test, which consists of 150 multiple-choice questions. Candidates for the CPMSM test have four hours to complete the CPMSM test, which has 175 multiple-choice questions.

Success Tip:

  • Plan to arrive at the testing center at least ten minutes before the scheduled testing appointment. Anyone who arrives late may not be admitted to the test.

Step 5: Maintain Certification

To maintain the certification, individuals must recertify with NAMSS every three years. For a single certification, individuals must complete 30 hours of continuing education. Individuals with a dual certification must complete 45 hours of continuing education.

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