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Donna Goestenkors

By: Donna Goestenkors on September 13th, 2016

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What’s in a Title? How the Role of Credentialing Professional is Changing

Payor Enrollment

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, could 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 is evolving and how your career might benefit from these changes.

Narrowing the Focus

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 some 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, payor 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 payor 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 audits.
  • Compliance Specialist 
    • This position ensures the department's practices and processes are accurate and compliant with all regulatory requirements.
  • 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 identified by an application specialist.
  • Expedited Credentialing Specialist 
    • The person in this position is an expert at fast-tracking an application through the process.

Expanding Responsibilities

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 payor enrollment, and many times their titles change to reflect the expanded purview of their roles. Take a look at some examples:

  • Physician Credentials Verification Coordinator
  • Manager of Credentialing and On-Boarding Specialist
  • Credentialing Software Product Manager
  • Provider Data Management and Credentialing SpecialistOften, 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 verifications, maintaining years’ worth of records, and distributing information across your organization. Cactus Credentialing eliminates paper files, protects sensitive data, automates verification and makes your life much easier. Learn more about medical credentialing software at or schedule a demo at


About Donna Goestenkors

Donna is a full time healthcare consultant, speaker, author, educator, and mentor serving the Medical Staff Services industry for over 40 years. Her diverse project experience includes assignments in every work environment and rapport building among all levels of professional and executive staff. Donna is a past President of NAMSS and her client work covers all of the industry's environments from Healthcare Systems to critical access hospitals.