Credentialing specialists are hired by health care organizations such as hospitals and group practices to verify the qualifications, certifications and educational background of staff members. The position is meant to ensure that facilities and personnel are in strict compliance with all regulatory measures so that patients get the best care available. As such, credentialing specialists play a pivotal role in the effective operation of an often complex industry.
As a credentialing specialist, you must research, compile and maintain reports that detail medical staff accreditation, organizational membership and adherence to facility policies. This includes fact-checking with various certification boards and agencies. All information must be entered into a secure online database and updated regularly. This database should include each medical provider's DEA certificates, state licenses and malpractice insurance coverage. You will also regularly complete and submit staff credentialing or re-credentialing applications to the appropriate agencies and track when certifications are due to expire. In some cases, you might even be tasked with overseeing the auditing of a facility or individual practitioner. Therefore, staying current on state and federal regulatory requirements is vital to the effective execution of your duties.
Self-motivated people will excel at a job like this, where direct supervision is minimal. You should be thorough, detail-oriented, and hold the notion of confidentiality in the highest regard. You must also have a positive, professional demeanor and the know-how to deal with a multitude of personality types. Strong research and organizational skills must be balanced with an ability to communicate effectively, both verbally and in writing. Proficiency with Microsoft Word, Excel and Access is a plus. In addition, the position often entails having to sit for prolonged periods and may include the lifting of heavy file boxes.
Education & Certification
The minimum educational requirement for a certification specialist is a high school diploma. However, most employers prefer you to have a two-year associate's degree in health information management, which includes the study of health care procedures, legal requirements, medical terminology and insurance processing. Some employers might even require you to hold a bachelor’s degree, although two to five years of credentialing experience will often suffice in lieu of a four-year degree. You should also be intimately familiar with the health care quality guidelines developed by the National Committee for Quality Assurance. After three years of work experience, you will be eligible to test for the Certified Provider Credentialing Specialist designation issued by the National Association of Medical Staff Services.
Salary & Economic Outlook
The U.S. Bureau of Labor Statistics reports that in 2010, around 179,500 workers were employed as medical record and health information technicians. The median annual pay was $32,350 per year or $15.55 per hour. Future prospects for such specialists appear bright, with the expected creation of 37,700 additional jobs between 2010 and 2020. This represents a 21 percent increase in employment, which is 50 percent faster than the projected growth rate for all U.S. occupations. These figures also coincide with the anticipated growth rate of the health care industry in general.
- Jupiterimages/liquidlibrary/Getty Images