How to Become a Certified Professional Credentialing Specialist

Learn how to become a certified professional credentialing specialist. Research the job description and the education requirements and find out how to start a career in credentialing.

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Do I Want to Be a Certified Professional Credentialing Specialist?

Certified professional credentialing specialists (CPCS) usually work in a healthcare organization such as a hospital, ambulatory care clinic, group practice, insurance company or a credentials verification organization. Duties generally include assisting with the credentialing and recredentialing process, making sure practitioners submit accurate and timely credentialing applications, maintaining the organization's credentialing database, reviewing any disciplinary reports or sanctions and participating in the credential verification process. Many of these professionals' work hours may be spent seated at a desk.

Job Requirements

Although not always required, at least an associate's degree in the healthcare field may be beneficial. Certification is optional, but may offer individuals increased job opportunities since many employers prefer hiring candidates certified by the National Association Medical Staff Services (NAMSS). The following table contains the core requirements for certified professional credentialing specialists:

Common Requirements
Degree Level No degree required, but some employers may prefer candidates with an associate's degree or higher**
Degree Field Healthcare or a related field**
Experience 3+ years*
Certification CPCS certification is optional but preferred by many employers**
Key Skills Excellent written and verbal communications, attention to detail, analytical skills, ability to prioritize work and manage deadlines**
Additional Requirements Familiarity with the provider credentialing policies and procedures,* experience with National Committee for Quality Assurance (NCQA)**

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

Step 1: Consider Earning a Degree

While having a high school diploma or GED is the minimum requirement for being a CPCS, many employers prefer hiring candidates with at least an associate's degree in healthcare or business. A 2-year degree is typically sufficient for this position; however, a 4-year degree can provide more support to an individual in a competitive job market.

Degree programs in healthcare-related fields generally combine courses such as medical terminology, ethics, administration and coding with liberal arts courses such as English, behavioral sciences and math. Business degree programs offer courses designed to prepare students for preparing and presenting reports. Coursework commonly includes accounting, economics, business communications and ethics.

Step: 2: Obtain an Entry-Level Job in Medical Services

To be eligible for the CPCS exam, candidates either hold a certified professional in medical services management (CPMSM) credential and have current working experience in medical services for at least 1 year, or have a total of 3 years of medical services experience in the past 5 years, with at least 1 year of current experience. Gaining an entry-level job in healthcare is an ideal way to fulfill this requirement while gaining hands-on experience in a medical environment.

Step 3: Prepare for the Certification Test

NAMSS offers a preparation course and an online prep course to help individuals prepare for the certification test. Aspiring CPCS candidates should be familiar with the privileging approval and application process, source verification, the credentialing application process, recredentialing policies and the regulations that apply to all medical environments.

Success Tip:

  • Take the CPCS practice exam. Taking the practice test helps familiarize candidates with the type of questions asked on the test. The practice test has 40 multiple-choice questions.

Step 4: Take the Certification Test

The test application can be accessed on the NAMSS website. After completing the application, individuals should mail it, along with the specified testing fee, to the NAMSS. After the application is approved, candidates receive a Notice to Schedule (NTS) by email. Candidates can schedule exam appointments online by choosing from available exam locations and appointment times.

CPCS candidates are allowed 3 hours to complete the 150 multiple-choice questions on the exam. Before starting the exam, candidates are allowed 15 minutes to complete a short tutorial to allow certification candidates to become familiar with the software. To pass the CPCS exam, individuals must receive a score of 400 or better.

Step 5: Maintain Certification

To maintain certification, the CPCS must recertify with NAMSS every 3 years. Eligibility for recertification includes submitting the recertification fee and completing 30 credits of continuing education. Individuals who fail to recertify on time must submit a new certification application and retake the exam to renew the certification.

Success Tip:

  • Maintain records of continuing education activities for 2 years after completing certification renewal. Although individuals don't have to submit documentation of continuing education during recertification, having the documentation on hand is important in case of an audit.
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