Credentialing Specialist Job Description

A Credentialing Specialist’s primary job is to ensure that the personnel of a facility, mainly healthcare, are properly trained, licensed and certified as mandated by state and federal regulations. In addition, they ensure that all services offered by these industries meet standards set by state and federal government agencies. A Credentialing Specialist would review applications, verify both individual and facility accreditation, maintain records of verification and work with auditors as needed.

In many cases, a Credentialing Specialist maintain databases in which they would input new information or update existing information regarding employee training, licenses, education, continuing education and relevant job experience. Credentialing Specialists are sometimes referred to as Medical Credentialing Specialists.

 

Credentialing Specialist Duties and Responsibilities 

Credentialing Specialists must complete a variety of tasks in verifying and maintaining licensure and other information for a healthcare facility. We have reviewed several job listings and found the following among the core Credentialing Specialist duties and responsibilities.

Verify Healthcare Credentials

It is up to the Credentialing Specialist to ensure that all necessary licenses and credentials are verified and updated for the healthcare facility in which they work. This might include conducting background checks, contacting licensing boards, reviewing license applications, obtaining education information and interviewing references.

Review Applications and Resumes

A Credentialing Specialist can assist with the new-hire process by going over information contained in job applications and resumes. They can help to ensure that applicants meet all licensing and credential requirements for the healthcare industry and for the specific position that is being applied for.

Assess Facility Practices

To ensure that a healthcare facility is operating within state and federal regulations, a Credential Specialist will review the ways in which services are being handled. They will also review facility-specific rules and regulations for compliance with internal processes.

Maintain Databases

Once they have compiled necessary documentation, most Credentialing Specialists will input information into a database. They might have several databases that track licensing, compliance with federal standards, completion of necessary training and education and continuing education completion.

 

Credentialing Specialist Skills

To be a Credentialing Specialist, one should be a detail-oriented, organized decision-maker with the ability to work both independently and in teams. Strong oral and written communication skills are also essential, as these specialists spend a lot of time communicating with doctors, healthcare administrators, higher education institutions and government officials. In addition to these general skills, a Credentialing Specialist could be expected by potential employers to possess the following skills.

Core skills: Based on job listings we looked at, employers want Credentialing Specialists with these core skills. If you want to work as a Credentialing Specialist, focus on the following.

  • Using strong research skills to gather pertinent information regarding healthcare facilities and staff
  • Keeping updated on medical licensing and certification requirements
  • Auditing paperwork such as applications and licensing documentation for accuracy
  • Processing privilege requests for healthcare employees at hospitals and other healthcare facilities
  • Understanding current healthcare laws and regulations

Advanced skills: While most employers did not require the following skills, multiple job listings included them as preferred. Add these to your Credentialing Specialist toolbox and broaden your career options.

  • Possess knowledge of basic computer programs, such as Microsoft Word and Excel, as well as database programs
  • Recognize credentialing guidelines of various organizations
  • Understand auditing processes

 

Credentialing Specialist Resources

It is beneficial to conduct research additional information if you are considering a career as a Credentialing Specialist. We have provided links to online and print resources about this career, which appear below.

On the Web

NAMSS Blog – Updated once or twice per month, this blog, hosted by the National Association Medical Staff Services, provides information about new regulations, healthcare practices and more.

ICE Blog – Hosted by the Institute for Credentialing Excellence, this blog offers links to ICE features and relevant industry news.

Industry Groups

Institute for Credentialing Excellence (ICE) – An association, founded in 1977, offering networking opportunities and information about educational requirements and trends in the credentialing industry.

National Association Medical Staff Services (NAMSS) – Formed in 1971, this organization offers support to Credentialing Specialists with continuing education opportunities, training webinars and advocacy.

Books

The Medical Staff Services Handbook: Fundamentals and Beyond, Second Edition – A practical overview of and advice for those in all types of medical staff services positions, including Credentialing Specialist.

Verify and Comply: Credentialing and Medical Staff Standards Crosswalk, Sixth Edition – A comprehensive look at the credentialing process, medical standards and regulations, and the responsibilities of a medical staff.

Credentialing and Privileging Your Hospital Medical Staff, Second Edition – This short but informative book provides details about the processes by which credentials and privileges are granted to medical personnel.

 

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