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certified provider credentialing specialist

How To Become A Certified Provider Credentialing Specialist?

The medical industry provides hundreds of interesting career opportunities. There are multiple professions for every person who wants to work in healthcare. We have already touched many job positions related to medical billing and coding, but here we will talk about a unique career, only a few people think of. Certified provider credentialing specialist is the one we discuss in this article.

Becoming a credentialing specialist is another great option to earn handsome pay while performing a meaningful role. These professionals make sure all healthcare staff and medical supplies have updated verified licenses which ensures trustworthiness among patients. 

Let’s find out about this career in detail and see what role they perform. Also, we will mention all the things needed to pursue this job so you can take a step toward your profession right away.

Who Is A Certified Provider Credentialing Specialist?

a person calling at a job

As you know, healthcare facilities are required to prove their credibility before providing health services. And hiring a specialist is a must that ensures your credentials are up to date. They play a crucial role in being associated with a hospital or clinic. Having them on the team enables you to conduct credentialing when needed and follow the ongoing practices regulatory authorities have defined.

Patients don’t trust the hospitals whose physicians haven’t shown their credibility. So a certified provider credentialing specialist makes sure all the staff is credentialed. If there is an expiry date coming up, they will inform the authorities too, so that they can renew the contract. 

So what are the things that are required to step in this career and other must-knows? Let’s see:

Required Education

Credentialing experts need to have a high school diploma as a basic education. But for extensive opportunities, you should go for at least an associate’s or bachelor’s degree. Though it’s a field of medical industry, for this role having a Business Administration background is preferred.


A certificate in any specific area opens the door for a high salary. Besides basic education, if you want to set yourself apart from other candidates pursuing the same career, taking certificates is the best option. It proves your ability to work in a position. So take some steps towards taking assessments and receiving a certificate in credentialing. You will get to learn practical things as well if you choose this option. 

One thing worth noting here is that taking a certificate is optional, so it’s up to you whether you go for a simple job or dedicate some time to enhancing your skills and securing a high-paying position.

Job Growth

The U.S. Bureau of Labor Statistics [BLS] found that job growth for certified provider credentialing specialists will be 32% until 2030. This is a comparatively faster growth rate than the 8% average growth rate for all jobs over the same time period.

Median Salary

Another thing we can’t miss when learning about certified credentialists is their salary. As we said, healthcare industries offer a lot of high-paying job positions; this one too is worth considering as a dream career. Here is an overview of the salary of a certified provider credentialing specialist in the United States:

  • Entry-Level: The median salary for entry-level professionals or those with limited experience ranges from $35,000 to $45,000 per year.
  • Mid-Level: For specialists with several years of experience or who have obtained additional certifications, the salary may range from $45,000 to $65,000 per year.
  • Senior-Level: Experienced credentialing specialists or those in managerial roles may earn median salaries ranging from $65,000 to $90,000 or more per year.

Key Skills A Credentialing Specialist Must Have

girl using laptop

You will be offered a job only when you have relevant skills. So this credentialing professional role also demands you to possess some specific competencies without which you won’t be able to perform your routine tasks. Have a look at these specialties they want you to have:

Understanding the credentialing process: You must have practical knowledge of credentialing processes like applying for credentials, verification, and payer enrollment procedures.

Medical terminology: Some healthcare facilities work in a specific area like oncology, dentistry, orthopedics, radiology, etc. When working for them, you must know the offerings and methodologies under which they provide their services. It will help you interpret the process better and define certain expertise in applications.

Proficiency in credentialing software: You must know how to operate credentialing systems to request a review, track credentialing status, and generate documents and analytical reports.

Document review and verification: Ability to carefully review and understand provider documents. This includes facility licenses, certifications, staff credentials, and potential references to fulfill credential criteria.

Audits: Carry regular credentialing audits to ensure providers continuously meet regulatory standards.

Knowing the healthcare regulations: You must be aware of the top healthcare rules i.e HIPAA and its impact on credentialing.

Besides these technical skills, a certified provider credentialing specialist must possess great communication, critical analysis, organizational, analytical, and problem-solving skills.

Where To Get Certifications To Become A Credentialing Professional

1 person handling over document to the other one

You have now learned pretty much about this fascinating healthcare career. However, in order to help you begin your journey we have compiled a list of top certificate providers of credentialing specialists. Review all of these and find out if any of the courses excites you:

1. Certified Billing and Coding Specialist (CBCS) 

by NHA (National Healthcareer Association)

CBCS certification covers medical terminology, ICD, and CPT coding systems, insurance claims processing, and healthcare reimbursement methodologies.

2. Certified Provider Credentialing Specialist (CPCS) 

by NAMSS (National Association of Medical Staff Services)

Professionals involved in provider credentialing and privileging processes are the intended audience for the CPCS certification. It addresses issues including provider enrollment processes, standards & credentialing laws, prioritization standards, and compliance needs.

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    3. Managed Healthcare Professional (MHP) 

    by HIAA (Health Insurance Association of America)

    Before the HIAA merged with America’s Health Insurance Plans (AHIP), it offered the MHP certification. It concentrated on the fundamentals of managed healthcare, encompassing managed care organizations, healthcare delivery systems, insurance ideas, and legal matters.

    4. Certified Coding Specialist (CCS) 

    by AHIMA (American Health Information Management Association)

    Proficiency in medical coding for inpatient hospital settings is validated by the CCS certification. It addresses subjects like CPT procedure coding, regulatory compliance, MS-DRG assignment, coding guidelines, and ICD diagnosis and procedure coding.

    5. Nationally Certified Medical Office Assistant (NCMOA) 

    by NCCT (National Center for Competency Testing)

    Medical office assistants who work in healthcare settings and conduct clinical and administrative tasks are intended to pursue the NCMOA certification. It covers topics like office management, basic medical terminology, patient communication, medical records management, and medical office procedures.

    Unlocking Opportunities

    Where other careers offer instability and inadequate pay, becoming a certified provider credentialing specialist is a great option to pursue. There are many other healthcare jobs as well under the domain of medical billing and coding. However, not all people can learn complicated billing processes and difficult codes. 

    So if you want a good-paying career with a comparatively less amount of skills, start credentialing. Give hospitals the credibility they desire and stay a valuable candidate in the entire healthcare facility.

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