Credentialing Specialist: Job Description, Duties and Requirements

Sep 19, 2019

Learn about the education and preparation needed to become a credentialing specialist. Get a quick view of the requirements as well as details about training, job duties, and certification to find out if this is the career for you.

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Doctors, nurses, and other health professionals typically hold several licenses and credentials, some of which need to be periodically renewed. Credentialing specialists are a type of human resource specialist employed by medical and health services facilities to assist medical employees with this process.

Essential Information

Credentialing specialists work for various healthcare organizations, including hospitals, group medical practices, and ambulatory care. They verify the professional licensing, training, and certifications of professional medical staff. Their primary goal is to ensure healthcare professionals and services meet all established federal and state standards, as well as NCQA (National Committee for Quality Assurance) standards. Most employers prefer credentialing specialists with a degree and certification.

Required Education Associate's degree or equivalent experience
Certification Certified with the National Association Medical Staff Services
Projected Job Growth (2018-2028)* 5% for all human resources specialists
Median Salary (2018)* $60,880 for all human resources specialists

Source: *U.S. Bureau of Labor Statistics

Credentialing Specialist Job Duties

Credentialing specialists maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations. They create and carry out various credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals. They ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.

Credentialing specialists generally process applications and reappointment paperwork, checking for full completeness and accuracy. They constantly collect and process significant amounts of verification and accreditation information, and thus must constantly maintain and update accurate databases for both practitioners and facilities. These databases include pertinent education, training, experience, and licensure content. Credentialing specialists must prepare their own records for regular auditing, as well as maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.

Credentialing Specialist Job Requirements

Requirements for credentialing specialists vary, but most employers prefer an associate's degree or equivalent training, as well as strong communication skills, according to an job search in October 2016. Becoming a Certified Provider Credentialing Specialist is also recommended because certification both develops knowledge and confidence regarding credentialing procedures, as well as greatly increases employment opportunities and future job security. Certification is available through the National Association Medical Staff Services.

Salary Info and Job Outlook

Although the Bureau of Labor Statistics (BLS) does not provide information specific to the field of credentialing specialists, it did project that the employment of human resources specialists will likely grow by about 5% between 2018 and 2028, a rate near the average predicted for all occupations. The BLS also stated that in May 2018, human resources specialists earned a median annual salary of $60,880.

Credentialing specialists ensure that all employees meet and maintain licensure requirements. In general, human resources specialists usually hold a bachelor's degree, although credentialing specialists may only need an associate's degree or relevant work experience. Holding certification may also help catch an employer's eye.

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