What is a Credentialing Specialist?

geekgolightly, BSN, RN · Nov 20, 2006

I saw an interesting ad in the paper, so I applied for the job. It is a Credentialing Specialist position. Requirements are RN licensure and proficient in Microsoft Office applications (thats me!) It is for a well-known health insurance company. They called me for an interview, so I'm trying to find out more about the job before I go in for the interview. I have found some information online. Can anyone else tell me more about this kind of work?

I was a credentialing specialist, but it was for a practice management company and did not need an RN license to do the work. my job was to ensure that all the necessary paperwork was done in order to receive hospital privileges (giving the physician the right to work in a hospital) as well as credentialing them for insurance contacts. credentialing specialists can also work in contract negotiations and contract scouting. i was also responsible for keeping the physicians up to date on their licensure and professional memberships and insurance.

lots of dull paperwork.

ERNP · Nov 20, 2006

I love and could not live without the credentialing specialist that works with me. I don't know what they would do at an insurance company, but if I had to keep up with all my own stuff.... I don't know if I would have time for anything else.

Daytonite, BSN, RN · Nov 20, 2006

As I am currently a health information management (HIM) student and taking a class in medical staff services, this is something we have just finished studying. A credentialing specialist is someone who verifies the professional licensing, training, practice skills and certifications of professional staff. Traditionally, they work in medical staff offices of acute hospitals and do the credentialing of physicians who are on the medical staff. However, in today's world credentialing is also needing to be done for advanced nurse practitioners like nurse anesthetists, physician assistants, surgical assistants, podiatrists, chiropractors and just about any other health care personnel who are working under the direct supervision of a doctor on the medical staff. Most nurses are not aware that doctors must apply to practice at a hospital, just as every other hospital employee fills out an application for a job. Most hospital employees, however, are screened through human resources. Doctors applications, on the other hand, are handled by credentialing specialists in the medical staff services office. There are certain federal and state information banks that they are required to access by law in the verification of these applications. It takes some training to learn what sites and how to access them are required. Unlike other hospital employees, the background of doctors is thoroughly investigated by the credentialing specialist and confidentiality is very important. An insurance company would be credentialing physicians, if they are some sort of managed care and any specialty professionals with licenses who they employ that are also working directly with patients such as dieticians, podiatrists or RN case managers. Normally, they would hire an HIM professional to do this job, so it's kind of interesting that they have specified that they want an RN for this position. One of the things credentialing is looking for is the practitioner who has a pattern of consistent or frequent settlements for the same types of medical mistakes or a pattern of poor evaluations or problems at previous facilities where they had privileges. The discovery of any lying on an application is, of course, usually something that results in the rejection of an applicant.

mharrah · Nov 20, 2006

Thanks. Does it pay well compared to other nursing jobs? I'm looking for at least 35K/yr.