What is a Medical Credentialing Specialist?

Updated February 2024

If you’re looking to get your foot in the healthcare door, a medical credentialing specialist position could be a promising start. Not only is it a great way to start learning about the healthcare industry, but it ensures that patients work with trained and certified professionals to receive quality care.

Let’s review the role in more detail as well as salary and career prospects.

What Is a Medical Credentialing Specialist?

A medical credentialing specialist is responsible for reviewing the qualifications of healthcare and medical professionals to make sure that all practitioners meet the standards set by the organization. Medical credentialing specialists are essential members of the healthcare team. Their day-to-day responsibilities include verifying credentials such as licenses and degrees, as well as making sure that providers are up to date on their continuing education requirements. Credentialing in jobs like this can assist physicians to nurses to allied health, and it is a vital part of the onboarding process at companies.

Medical credentialing specialists typically work in the human resources or medical records departments of hospitals and other healthcare facilities. Some may also work for third-party organizations that provide credentialing services to multiple clients.

Responsibilities of a Medical Credentialing Specialist

The job duties of a medical credentialing specialist can vary depending on the size and type of organization they work for. In general, though, their responsibilities may include:

Maintaining provider databases
Processing applications for new staff members
Conducting background checks
Verifying credentials

These type of specialists could also be responsible for tracking provider privileges and renewals and investigating any complaints against providers.

Transferable Responsibilities

If you’re looking to hiring a medical credentialing specialist, consider the transferable skills and knowledge they may have acquired from other roles within the healthcare industry. It’s common to hire medical credential specialists with backgrounds in other healthcare roles, such as:

Credentialing Coordinator: Similar to a medical credentialing specialist, coordinators are entry-level roles that support the credentialing process.
Medical Staff Coordinator: In some health facilities, a medical staff coordinator handles credentialing and privileges for medical staff members.
Medical Affairs Coordinator: This role often involves managing administrative aspects of medical staff affairs, including credentialing and privileging processes.
Quality Assurance Coordinator: Professionals involved in ensuring the quality and compliance of healthcare services may have skills applicable to credentialing.
Medical Coder: Medical coders translate reports into code for insurance companies to process claims. Their medical knowledge and attention to detail make them an easy role to pivot into credentialing.
Medical Biller: Similar to coders, billers submit insurance claims and have a good combination of medical proficiency and organizational skills to pivot into credentialing.

6 Important Skills for Medical Credentialing Specialists

Some of the expertise needed for this role include:

Strong Organizational Skills: Organizational skills are important for medical credentialing specialists since they must keep track of multiple deadlines and ensure that all the required documentation is in order. Lack of organization could lead to errors that could jeopardize a provider’s ability to practice.

Attention to Detail: Since medical credentialing specialists are responsible for verifying credentials, it is essential that they have a strong attention to detail and can spot even the smallest error.

Writing Skills: Since medical credentialing specialists often have to communicate with providers, it is important that they have strong writing skills to clearly and concisely explain any process or requirements. They may also need to write letters of recommendation or other types of correspondence.

Technical Skills: It’s also helpful for these credentialing specialists to have strong computer skills including various software programs, databases and spreadsheets. In today’s world, most businesses use some type of computerized system (medical credentialing included).

Communication Skills: Effective communication with providers and other staff members in the organization is the key to smooth collaboration and productivity.

Strong Research Skills: They may sometimes have to research medical terminology, provider backgrounds, or other topics related to the role on a regular basis.

The credentialing process requires a great deal of attention to detail and accuracy. However, these specialists are typically able to work independently and have a high degree of control over their workday.

Education Requirements

A bachelor’s degree is sometimes preferred for this position. However, some employers hire medical credential specialists with a high school degree or a two-year college degree. The National Association Medical Staff Services (NAMSS) offers the Certified Provider Credentialing Specialist (CPCS) credential.

Pay and Job Outlook

According to Salary.com, the median annual compensation for medical credentialing specialists is around $43,000.

Employment in the medical field is projected to grow 32 percent from 2020 to 2030, much faster than the average for all occupations. In addition, the aging population and recent changes to healthcare laws are expected to increase the demand for qualified healthcare providers, leading to more job openings for medical credentialing specialists.

Hire a Medical Credentialing Specialist

The role of a medical credentialing specialist is essential to hospitals and other healthcare organizations. If you are interested in pursuing this career, we have a team of experts waiting to find you the best opportunity for your needs an skillset.

Maybe you’re a hiring manager looking to add to your staff and need a medical credentialing specialist (or another type of healthcare operations role), we can help with that too!

Whether you’re seeking or searching, connect with us today!