Hot Job: Medical Credentialing

By Glenda Byers Shaffer, M.Ed., Adjunct Faculty

CTU Healthcare degree - Medical CredentialingThose who aspire to work in the medical field tend to work toward more commonly known professions, such as a physician or nurse. Perhaps a great career you’ve never considered before is as a medical credentialist. Credentialists ensure that state laws and accrediting body requirements are developed and met for ongoing quality of care provided by physicians and other health professionals.

The credentialing professional is referred to as a manager of medical staff services, medical staff coordinator, credentialing specialist or director of credentialing. An entry-level professional’s title may be as a credentialing assistant or associate. Primary job functions for this field include:

  • Overseeing processing of credentialing of all physicians and health practitioners within their specialties.
  • Maintaining knowledge of standards of the Joint Commission on Accreditation of Healthcare Organizations, National Committee on Quality Assurance (NCQA), state and federal regulations, and legal cases related to medical staff organization.
  • Developing, establishing and enforcing medical staff bylaws, rules and regulations, and policies that govern the activities of medical staff.
  • Assisting a credentials committee with development of criteria and other documents necessary to provide an effective credentialing process.
  • Documenting the activities of a medical staff executive committee.
  • Ensuring computerized documentation is completed for all credentialed physicians and other health professionals.
  • Supervising staff that performs the above functions.

A job description for a medical credentialist might read like this:
Responsible for coordination and oversight of the medical staff services department, to include physician credentialing, managing meetings and providing for a flow of information from medical staff committees to the medical executive committee and governing board. Assist with Joint Commission (JCAHO) survey preparation. Work closely with medical staff leaders, hospital administration and legal counsel to ensure required items from the medical staff bylaws and policies are developed and followed.

What are the educational and other requirements you’ll need for this type of position? They include:

  • An associate or bachelor’s degree in healthcare management
  • Two certifications - Certified Professional Medical Services Management (CPMSM) and/or Certified Provider Credentialing Specialist (CPCS)
  • Affiliation with the National Association of Medical Staff Services (NAMSS)
  • Excellent interpersonal skills, including the ability to communicate professionally both verbally and in writing.

CTU Faculty - Glenda Byers ShafferWith more than 15 years of experience in health care and higher education, Glenda Shaffer, M.Ed. is an adjunct faculty member at CTU. She holds a bachelor’s in business administration and actively serves on CTU’s Health Administration Program Committee, a group that reviews and updates CTU courses.

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Image credit: Flickr/Funky64