What does a Medical Credentialing Specialist do

The health care industry is a tight-knit web of various administrative services contributing to its smooth functioning and growth. Medical credentialing is one such administrative service that is imperative to the health care industry’s efficiency. The purpose of medical credentialing is to verify the credentials of candidates before hiring them as doctors. This helps hospitals to hire highly qualified candidates with exceptional medical knowledge, training, and skills. It is the responsibility of the medical credentialing specialist to verify the credentials thoroughly and select the best candidates. There’s no room for error because a minor mistake in the credentialing process may affect the productivity of hospitals. It is, therefore, hospitals prefer to outsource medical credentialing services from a prominent medical billing company.

Considering the importance of credentialing, the medical credentialing specialist needs to be highly qualified and must possess a degree in business administration or an associate’s degree in health care. In a few cases, candidates applying for the post of the medical credentialing specialist may also be required to have a Certified Provider Credentialing Specialist (CPCS) certification. The candidate needs to get CPCS certification from National Association Medical Staff Services (NAMSS). This establishes the candidate’s eligibility for the post of the credentialing specialist. The job of a medical credentialing specialist may include the following tasks.

Verification of Credentials

The primary job of the medical credentialing specialist is to verify the credentials of the hospital staff, nurses and doctors. It is the responsibility of the credentialing specialist to ensure that all the credentials provided by the candidates seeking a job in a hospital for various positions are true and valid.

Reviewing Applications/Resumes

Candidates tend to make mistakes in their applications. Some candidates may also provide false information in their applications or resumes. Therefore, the medical credentialing specialist must review all the applications and resumes before processing them.

Monitor Certificates/License

The credentialing specialist must be able to keep track of certificates and licenses for their expiration. Some certificates and licenses are required to be renewed from time to time.

Compliance Management

The credentialing specialist must be able to maintain compliance with the insurance provider and all the medical regulatory and accrediting institutions.

Maintain Record/Database

The credentialing specialist is required to marinate the record and update the database for credentials, certifications, licenses, and insurance contracts.