What Does a Credentialing Specialist Do?

Credentialing Specialists ensure that medical staff members’ maintain current credentials and licenses to work legally in their field or specialty. These credentialing specialists monitor upcoming renewal dates and work with medical staff to advise them of the required steps to maintain their credentials. They also review information on potential new employees to make sure all required licenses and credentials are current before hiring.

Outsourced credentialing specialists are informed about the regulations and standards required to achieve and maintain licensure and other credentials. A thorough knowledge of applicable medical policy is also needed and held by qualified third party providers such as Eddy.

Credentialing specialists often work as third parties. This requires the specialist to be able to manage their workloads effectively to meet set deadlines. Strong computer skills are necessary for the input and maintenance of data, as well as for performing research regarding licensing or credentialing requirements in their area. Interaction with other medical professionals, office personnel, and the public is standard.

The standard job duties of a credentialing specialist are to:

  • Maintain compliance with all regulatory and accrediting institutions
  • Monitor staff credentials and licenses
  • Advise staff on renewal procedures
  • Participate in the development of internal credentialing processes
  • Keep records in licenses, credentials and insurance contracts
  • Release information to agencies and members of the public as required by law

The typical education and qualifications for a credentialing specialist are:

  • a Certified Provider Credentialing Specialist (CPCS) certification through the National Association Medical Staff Services (NAMSS) may be required, though experience may substitute in certain situations
  • Education beyond high school is often required
  • A few years of experience performing similar duties in a medical facility

Access to Superior Credentialing Specialists

If you or your organization is considering hiring an internal credentialing specialist it would be in your best financial as well as compliance interest to consider a third party provider for all your credentialing needs. There is a significant cost saving to enlisting the services of Eddy, a premier third party credentialing provider. Their team of industry experts will help to maintain compliance and efficiency for your organization. Contact Eddy today to learn how they can help your healthcare organization thrive.

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