Medical Credentialing Specialist Job Description
Medical credentialing specialists are typically employed by different types of health care organizations, such as hospitals, group practices, ambulatory care services, and credentialing agencies. A specialist's main focus is to verify that the credentials of health care professionals are in compliance with state and federal standards. This can involve verifying the legitimacy of practitioner information with universities, licensing agencies, and certification groups. Along with processing re-credentialing paperwork and maintaining a database of practitioners' training, education, licensing, and experience information, specialists also ensure that practitioners adhere to staff policies, department regulation, and government laws.
Medical Credentialing Specialist Requirements
Medical credentialing specialist positions require an associate's degree in health care or business administration or three years of experience in a medical office. Other requirements include interpersonal and organizational skills, as well as knowledge of administrative tools like word processing and spreadsheet applications. Must be proficient with PECOS, CAQH, NPPES as well as the credentialing and re-credentialing process