Are you interested in a healthcare career that doesn't involve directly working with patients? Perhaps you're looking for an administrative role that helps providers stay up to date on education and policy.
If this sounds like you, consider becoming a certified provider credentialing specialist.
In this article, we'll define this type of professional, discuss the job duties involved, and give you a step-by-step outline you can follow to pursue this career.
What Does a Certified Provider Credentialing Specialist Do?
Credentialing specialists, also known as medical credentialists, ensure that medical professionals such as doctors, nurses, and technicians adhere to certification and licensure requirements.
Their job is to understand and execute local, regional, and state regulations regarding medical credentialing, as well as the requirements established by individual healthcare facilities.
This career path comprises various administrative job duties, including:
- Maintaining and updating provider databases
- Developing and implementing procedures for credentialing
- Ensuring all providers have current and appropriate credentials
- Monitoring certification requirements within and without healthcare facilities
- Assisting with hiring new providers
Certified provider credentialing specialists work for hospitals and other types of care facilities, as well as ambulatory services, government departments, and credentialing agencies.
What Skills and Qualities Do Certified Provider Credentialing Specialists Have?
Certified provider credentialing specialists must have a strong understanding and awareness of all credentialing policies and regulations relative to the providers at their care facility.
Attention to detail is also a critical skill to have, as credentialing specialists must maintain error-free records and databases and ensure that providers adhere to all regulations.
Much of their job involves communicating with healthcare providers at all levels, as well as government officials, fellow administrators, and members of educational institutions.
These professionals must be able to work independently and as part of a team, handle the pressure of tight deadlines, and deal ethically with the sensitive information they regularly encounter.
So, do you want to become a certified provider credentialing specialist? Follow the steps below.
1. Get Your High School Diploma or GED
Graduating high school or obtaining an equivalency diploma is the most basic level of education you need to have to become a medical credentialist.
Some employers will hire candidates with only a diploma or GED provided they have a significant amount of medical office experience.
However, candidates with a college education typically have the best chance of landing the job. To obtain this education, you must have a diploma or GED to be eligible to attend college.
So, regardless of the specific path you pursue, obtaining a diploma or GED is a necessary first step to becoming a certified provider credentialing specialist.
2. Complete an Associate's Degree
Most aspiring medical credentialists pursue an associate degree in business administration, healthcare administration, or a related field.
Many employers require at least an associate degree, along with relevant experience. Those attending college may have opportunities to work internships that otherwise would not be available to them.
Most associate degrees take about two years to complete if you are studying full-time.
3. Complete Additional Training
Some employers may require you to complete additional training to become a certified provider credentialing specialist.
They may provide this specialized on-the-job training through their facility or refer you to another training program.
Additionally, some employers may prefer that you hold a bachelor's degree instead of an associate degree.
While this usually isn't a requirement, you may choose to pursue a bachelor's degree to improve your career prospects and pursue management roles within the medical credentialing field.
Good bachelor's degree programs include healthcare management and business and typically take about four years to complete.
4. Gain Relevant Experience
Whether you choose to pursue advanced education or decide to work your way up with only a high school diploma, you will need to gain work experience before you can become a credentialing specialist.
If you're just starting, look for internship opportunities in your area, or ask a local healthcare facility if you can shadow a certified provider credentialing specialist.
You can also look for entry-level job opportunities as a medical office assistant or in related roles. Look for opportunities to gain experience specifically in credentialing.
It may take some time to build up this experience, but it is a necessary part of the process. Even if you have a college degree, you will need to spend some time gaining experience and working your way up.
5. Get Certified
To become a certified provider credentialing specialist, you will need to pursue certification from the National Association of Medical Staff Services.
This credentialing agency offers two certifications, the first of which is the certified provider credentialing specialist (CPCS) credential.
To be eligible for this certification, you must have been employed for twelve consecutive months during the previous two years in a medical services field.
You also need to have gained three years of experience within the previous five years.
If you meet these requirements, you will need to pass an exam and complete ongoing education requirements throughout your career to achieve and maintain your certification.
Become a Certified Provider Credentialing Specialist Today
Certified provider credentialing specialists or medical credentialing specialists play an important administrative role within the healthcare field.
To pursue this rewarding career, follow the steps provided in this article.