Insurance Credentialing Specialist: Job Description and Requirements

Sep 19, 2019

Insurance credentialing specialists require little formal education. Learn about the training, job duties, and certification to find out if this is the career for you.

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Insurance credentialing specialists make sure that the licenses and credentials of medical professionals are properly documented to meet insurance regulations. They typically have some post-secondary education. Earning professional certification might make them stand out to potential employers.

Essential Information

An insurance credentialing specialist usually works for a hospital or insurance agency to verify the medical staff's credentials and ensure insurance forms are processed properly. Some positions require candidates to have only a high school diploma, but many prefer individuals with an associate's degree and experience in a clerical or health care position.

Required Education post-secondary certificate or associate's degree
Optional Certification Certified Provider Credentialing Specialist (CPCS)
Projected Job Growth (2018-2028) 11% for medical records and health information technicians*
Average Salary (2018) $44,010 annually for medical records and health information technicians*

Source: *U.S. Bureau of Labor Statistics

Insurance Credentialing Specialist Job Description

Insurance credentialing specialists are generally employed by health care facilities, insurance groups and credentialing agencies. A specialist's primary function is to ensure that the facility and its staff fulfill government credentialing regulations and are properly enrolled with insurance agencies.

Duties are primarily administrative and include tasks such as processing and filing reports, confirming provider's information with accrediting and licensing agencies and maintaining a database of provider and client information. Specialists also work closely with insurance agents to supply them with physician and client information and request reimbursement for services rendered to insured clients.

Education Requirements

Insurance credentialing specialist positions may require a high school diploma or an associate's degree in healthcare or administration. Employers might also prefer candidates with at least two years of clerical or medical administration experience, according to a November 2010 job search.

Proficiency with computers is helpful, especially with database applications, spreadsheets and word processing software. Since specialists work closely with physicians and insurance agents, the position requires communication skills and a professional attitude. Aspiring insurance credentialing specialists might familiarize themselves with standards outlined by the National Committee for Quality Assurance, an authority on health care quality and credentialing guidelines in the U.S.

Career Requirements

Earning voluntary certification might lead to increased job opportunities for insurance credentialing specialists. A Certified Provider Credentialing Specialist (CPCS) designation demonstrates experience in the health care industry. The National Association of Medical Staff Services (NAMSS) offers a CPCS program to credentialing specialists in good standing who have a minimum of a year of experience in medical administration. According to NAMSS, more than 27% of credentialing specialists enjoyed an increase in wages after earning the CPCS designation.

Career Info

According to the U.S. Bureau of Labor Statistics, medical records and health information technicians - a group of professionals with duties similar to insurance credentialing specialists - could expect to see a 11% increase in job opportunities from 2018 to 2028. They earned a median annual salary of $40,350 in May 2018, with those working in hospitals earning slightly more at a mean of $46,690, and those working in doctors' offices earning less at a mean of $37,720.

An insurance credentialing specialist needs an associate's degree or a certificate in a relevant field. The BLS predicts faster than average growth over the next decade for these jobs. More opportunities may be available for those with computer skills and CPCS certification.

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