credentialing ecosystem

How to Become a Certified Provider Credentialing Specialist


Be it a hospital or a health care system, Certified Provider Credentialing Specialist plays a key role in managing the regulations, credentialing the physicians and in keeping a database & reports of verification information. There are plenty of opportunities including credentialing certification which are anticipated in the field of health care for this promising role. The role involves having a great grasp on communication & organization which is heavily needed for reviewing multiple applications & verification letters & much more. The certified provider credentialing specialist generally assists with the credentialing and re-defining the process of credentialing. They ensure the practitioners has submitted the exact and authentic credentialing applications including the maintenance of the company’s credentialing database as well. They are also responsible for reviewing the reports, sanctions or any verification process.

A certified Provider Credentialing Specialist work in health care organizations mostly and they’re responsible for professional licensing, training & all of the certifications of professional medical staffs. The aim is to make sure all the healthcare professionals & services meet the industry benchmark & remain up to the standards.

Now let’s have a quick look on one can become a Certified Provider Credentialing Specialist:

  • First of all, an associate’s degree is a must because many of the organizations prefer candidates who are having an associate’s degree. Usually, an associate degree in medical staff services takes two years to finish. The course will equip the person with the knowledge of verifying the credentials of health care providers & laws. Along with it, the course includes medical law, terminology, management, medical staff services, anatomy, and physiology. However, it would be also advantageous to get a degree as some recruiters opt for candidates like them as well. After finishing the high school diploma, one can apply for the associate’s degree. Look up for the best credentialing ecosystem.

Pro Tip: As Credentialing specialists are often working with computers, it is a good idea to get proficient with the latest technology & office and business programs like Excel & Microsoft Word.

  • Sometimes Credentialing Specialists role requires 1 to 3 years of experience in the relevant field. The potential job applicants can get valuable experience by taking up an entry-level job in medical staff services or in the management team in health care field. In order to be well prepared, it is advisable to study the auditing process in advance.

• After having an experience of at least 3 years in the health care industry, one can get certified through the NAMSS (National Association Medical Staff Services). It is recommended because being certified by the NAMSS will eventually help in developing the knowledge & confidence on credentialing processes along with a better job security. To get certified you need to have at least 3 years of experience & employment of past 12 months in the relevant position. In every three years, re-certification is needed and having credentialing certification helps to advance in career. A certification gives you expertise in the field which increases the value & security of your job. Along with that, it increases recognition & advancement for the career.

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