What’s In a Title? How the Role of the Credentialing Professional Is Changing

In your role as a credentialing professional, you likely tackle many tasks and projects at work each day. Some tasks, like sending and receiving verifications, certainly benefit from new 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 work day includes, you need to understand how the credentialing role and the medical staff services department are evolving and how your career might benefit from these changes.

Narrowing the focus of credentialing titles

To really understand the career potential that exists for credentialing professionals, take a look at some of the position titles that exist around the country. By learning about what's happening in the industry, you can potentially make changes that may benefit your career and your healthcare organization.

While the most common titles are credentialing coordinator and credentialing specialist, the industry is beginning to see more opportunities for professionals to sharpen and apply their skills to one particular area of expertise. 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, payer 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 payer enrollment
• Initial application specialist 
  • The person in this role focuses only on new 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 practices and 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 applying
• Red flag specialist 
  • This role is responsible for investigating any area of concern that an application specialist identifies
• Expedited credentialing specialist 
  • The person in this position is an expert at fast-tracking a credentialing and/or privileging application through the process. They frequently attend credentialing committee meetings.

Expanding responsibilities of credentialers

On the flipside, many organizations are asking healthcare credentialing professionals to take on additional aspects of the department. For example, many are now responsible for provider or payer enrollment, and often their titles change to reflect the expanded purview of their roles. Take a look at some examples:

• Provider credentials verification coordinator
• Specialist or manager of credentialing and onboarding 
• Credentialing software product manager
• Provider data management and credentialing specialist

Often, the people in charge of credentialing are expected to master provider credentialing software to help the entire department take advantage of the efficiencies such a system can provide. The title of credentialing software "superuser" is now showing up in various organizations as providers realize the benefit of having someone on staff who can serve as an expert in navigating the physician credentialing software for the department. 

Cultivate new opportunities

If you would like to accelerate your career growth, think about what you do on a day-to-day basis. If you see a job title that more accurately fits your role, it might be worthwhile to propose a title change to your department leader. You may be able to more clearly define your position and focus your work on a particular 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 your career field and the opportunities that exist for advancement, you can truly set yourself up for success. 

For a deeper exploration of what you can do to boost your career as a healthcare provider credentialing professional, listen to the symplr webcast, Accelerating Your Credentialing Career.

Take the headache out of your most complicated, sensitive and error-prone processes—from gathering and storing provider data to performing primary source verification, maintaining years’ worth of records, and distributing information across your organization. symplr Provider Data Management eliminates paper files, protects sensitive data, automates verification, and makes life easier for you and your providers.