As a credentialing professional, you likely tackle many tasks and projects each day. Some tasks, like sending and receiving verifications, certainly benefit from automated technologies to make you more efficient. Others, such as investigating red flags on new applications, take more time—and a human touch.
But no matter what your workday includes, you need to understand how the medical credentialing role within the medical staff office is evolving and the variety of positions that continue to expand.
What are the responsibilities for specialized credentialing roles?
To really understand the career potential that exists for credentialing professionals, we’ve included some job titles that exist around the country. By learning about what’s happening in the industry, you can potentially make changes that could benefit your career and your healthcare organization.
While the most common titles are credentialing coordinator and credentialing specialist, the industry is expanding job titles for medical service professionals. Some examples of this new specialization include:
- Credentialing and concierge coordinator
- This role manages a new physician from the point of first contact through recruitment, signing of the contract, credentialing, provider enrollment, and onboarding.
- Application specialist
- This person manages the process of application completion, not only for hospital credentialing but also physician office credentialing, managed care, and provider enrollment.
- Initial application specialist
- The person in this role focuses only on new provider applications.
- Credentialing audit specialist
- This job title is reserved for those who exclusively perform credentialing audits.
- Medical staff compliance specialist
- This position ensures the medical staff service department’s processes are accurate and compliant with all regulatory requirements. The individual is a liaison with the quality department/quality professionals.
- Temporary privilege specialist
- This expert manages all temporary privileges and any red flags regarding those providers applying for temporary privileges.
- Red flag specialist
- This role is responsible for investigating any area of concern that an application specialist identifies during the provider application process.
- Expedited credentialing specialist
- The person is an expert at fast-tracking a credentialing and/or privileging application through the process. They frequently attend credentialing committee meetings.
Evolving requirements for medical credentialing professionals
As the medical staff office is asked to do more with less, many organizations are asking healthcare credentialing professionals to expand their scope of work and take on additional roles within the department.
For example, many medical staff office teams are now responsible for provider enrollment, and often their titles change to reflect the expanded roles. Below are a few examples of expanding job titles:
- Provider credentials verification coordinator
- Manager of credentialing and onboarding
- Credentialing software product manager
- Provider data management and credentialing specialist
- Provider enrollment specialist
Often, the people in charge of credentialing are expected to master provider credentialing software to streamline the credentialing and privileging process. The title of credentialing software “superuser” is now showing up in organizations as providers realize the benefit of having an expert on staff to navigate and train others on the credentialing software for the department.
Tips for career growth in medical credentialing
If you would like to accelerate your career growth as credentialing professional, think about what you do on a day-to-day basis. If you see a job title that more accurately reflects your role, it might be worthwhile to propose a title change to your department leader. That way you can clearly define your position and focus on an aspect you enjoy the most.
If you’re looking for a new job, try using these new or specialized titles in your search for open positions. Also, during the interview stage, listen to how the organization describes the position, and think about how the title could be changed or used as a negotiation point for you. By learning more about the medical credentialing field and the opportunities that exist for advancement, you will set yourself up for success.
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