Certified Physician Credentialing Specialist: Job Duties & Requirements

Sep 25, 2019

Learn about the education and preparation needed to become a certified physician credentialing specialist. Get a quick view of the requirements, as well as details about certification and job duties.

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Most hospitals and other medical facilities employ certified physician credentialing specialists to monitor the licensing and credentialing requirements of all employed physicians. Although physician credentialing specialists do not interact with patients directly, they are an integral part of any medical administrative team because they ensure that physicians are lawfully credentialed to practice medicine. To become certified, credentialing specialists must meet education and experience requirements.

Essential Information

A physician credentialing specialist is an administrative worker in the medical industry who ensures that physicians and other medical care staff have proper credentials and meet regulatory requirements. The requirements for becoming a physician credentialing specialist vary by employer, and some employers may only require a high school diploma. Optional certification is offered by the National Association Medical Staff Services (NAMSS). This certification may enhance job prospects for these professionals.

Required Education Postsecondary certificate or associate degree
Other Requirements Certified Provider Credentialing Specialist certification is required by some employers, which requires individuals to possess sufficient job experience
Projected Job Growth (2018-2028) 11%* (for all medical records and health information technicians)
Median Salary (2019) $43,555** (for all credentialing specialists)

Source: *U.S. Bureau of Labor Statistics (BLS), **PayScale.com

Credentialing Specialist Job Duties

Working with healthcare administration staff, a credentialing specialist or coordinator is responsible for maintaining accurate records of the credential and license information of medical care staff, including physicians, technicians and nurses. In keeping these records, the specialist monitors when credentials are expiring, making sure all providers meet accrediting and regulatory standards. They may also be in charge of reviewing the credentials of job candidates and giving credentials in employer-sponsored training programs.

In large clinical healthcare facilities like hospitals, the credentialing specialist reports to the medical director or staff manager. In addition, the specialist may also perform general clerical and administration duties relevant to credentialing and medical services. These can include:

  • Maintaining and updating internal credentialing policies and procedures
  • Preparing credential applications
  • Insurance and billing tasks
  • Attending meetings and taking minutes
  • Keeping detailed and organized files and records

Salary and Employment Outlook

Payscale.com reports a median salary of $43,555 for all credentialing specialists as of September 2019. Medical records and health information technicians are expected to see 11% growth in employment between 2018 and 2028, according to the U.S. Bureau of Labor Statistics (BLS).

Education and Job Requirements

According to November 2016 job postings on Monster.com, formal education is not required for every credentialing specialist position. Some employers, however, prefer an associate's or higher degree in business administration or a field related to healthcare. Some job experience in administration assistance or professional credentialing is preferred for most positions.

Per data from the BLS, certified physician credentialing specialists fall under the category of health information and medical records technicians. These professionals usually need some sort of postsecondary certificate or in some cases an associate's degree to find employment.

Certification Information

Certification is provided by the National Association Medical Staff Services (NAMSS) in the form of the Certified Provider Credentialing Specialist (CPCS) exam. To be eligible for the exam, the candidate must have three years' experience in a medical services profession and must have been employed in a related field for at least one year prior to application.

The three-hour CPCS exam covers credentialing knowledge, primary source verification, compliance and logistical operations. The NAMSS offers an in-person training course for those looking to prepare for the exam. Once granted, CPCS certification lasts three years.

Certified physician credentialing specialists are a vital part of the medical staff services team, as they verify that all staff physicians meet the necessary credentialing and registration requirements. Job duties may include reviewing credential applications, monitoring credential requirements, communicating with staff members, and maintaining confidential files. The certification process requires at least three years of experience in medical services and passing the certification exam.

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