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Medical Credentialing Specialist: Job Description and Requirements

A medical credentialing specialist ensures that a health care facility and its staff's credentials meet government and accrediting agency standards. An associate's degree along with communication, organization, and administrative skills can begin a career in medical credentialing, but professional certification may greatly increase job opportunities and wages.

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Medical Credentialing Specialist Job Description

Medical credentialing specialists are typically employed by different types of health care organizations, such as hospitals, group practices, ambulatory care services, and credentialing agencies. A specialist's main focus is to verify that the credentials of health care professionals are in compliance with state and federal standards. This can involve verifying the legitimacy of practitioner information with universities, licensing agencies, and certification groups. Along with processing re-credentialing paperwork and maintaining a database of practitioners' training, education, licensing, and experience information, specialists also ensure that practitioners adhere to staff policies, department regulation, and government laws.

According to the U.S. Bureau of Labor Statistics (BLS) in 2012, medical records and health information technicians, such as medical credentialing specialists, typically worked 40 hours per week and many had possible overtime opportunities (www.bls.gov). Credentialing specialists typically work in office settings and, unlike most health care occupations, don't work directly with patients. Employment for medical credentialing specialists was expected to grow faster than average between 2012 and 2022, at 22%, an effect of more complex medical technologies and approaches, and an increased concern of legal liability among healthcare facilities and practitioners.

Medical Credentialing Specialist Requirements

Medical credentialing specialist positions generally require an associate's degree in health care or business administration or two years of experience in a medical office. Other requirements generally include interpersonal and organizational skills, as well as knowledge of administrative tools like word processing and spreadsheet applications.

Earning the Certified Provider Credentialing Specialist (CPCS) designation may increase job opportunities for medical credentialing specialists. The National Association Medical Staff Services (NAMSS) offers a CPCS certification program for medical service professionals in good standing with at least 12 consecutive months of experience in the field. According to NAMSS, over 27% of crediting specialists earned an increase in wages after earning their certification (www.namss.org).

Salary Info

The BLS published in May 2013 that the median annual salary earned by medical records and health information technicians, including medical credentialing specialists, was $34,970. Those working in medical and surgical hospital were reported by the BLS to have earned average (mean) annual salaries of $40,100. Individuals working for pharmaceutical companies averaged more than $52,000 a year, per the BLS in 2013.

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Source: Bureau of Labor Statistics