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Credentialing assistant skills for your resume and career

Updated January 8, 2025

3 min read

Below we've compiled a list of the most critical credentialing assistant skills. We ranked the top skills for credentialing assistants based on the percentage of resumes they appeared on. For example, 18.2% of credentialing assistant resumes contained data entry as a skill. Continue reading to find out what skills a credentialing assistant needs to be successful in the workplace.

15 credentialing assistant skills for your resume and career

1. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how credentialing assistants use data entry:

Performed data entry and insurance verification duties.
Abstract Specific Information for Provider Credentialing Data Entry of Statistical Information for HEDIS 3 Support Staff for Quality Assurance Department

2. Insurance Carriers

Here's how credentialing assistants use insurance carriers:

Contacted licensing agencies, and insurance carriers to complete Credentialing and re-credentialing applications.
Communicated via email and telephone with dentists and insurance carriers to request information.

3. CAQH

Here's how credentialing assistants use caqh:

Supported credentialing administrators with entering providers into CAQH.
Experienced in pull and set up applications from CAQH as well as strong knowledge healthcare credentialing experience.

4. Primary Source Verification

PSV or Primary Source Verification is needed for confirming if an individual holds a valid certification, license, or registration to practice a particular profession as required by regulation or law. Methods for conducting PSV include direct correspondence, securing electronic verification, documented telephonic verification, or collecting reports from credentials verification organizations.

Here's how credentialing assistants use primary source verification:

Input provider primary source verification information for fellowships, medical school attendance, insurance coverage and work history in Visual Cactus.
Facilitate credentialing functions, such as application management and primary source verification for physicians and mid-level providers.

5. Health Professionals

Here's how credentialing assistants use health professionals:

Scanned, audited, and processed applications for physicians and allied health professionals applying for privileges at South Miami Hospital.
Coordinated orientation for new physicians, allied health professionals and other health professionals credentialed through the Medical Staff Department.

6. NCQA

Here's how credentialing assistants use ncqa:

Prepare all Credentialing applications, coordinate the Credentialing process in accordance with NCQA guidelines and Rockford Health Plans policies & procedures.
Research and collect needed data for Initial credentialing applications and reappointment applications to meet NCQA and JCAHO standards.

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7. DEA

Drug enforcement agents are specialized law enforcement officers, deployed to fight crime, especially drug-related offenses like the purchase and sale of illegal drugs. DE agents are physically fit and trained with the proper understanding of the law, training, and education.

Here's how credentialing assistants use dea:

Pull expiration reports for DEA, Medical License and Malpractice insurance 90 days in advance and mail out reminders for renewals.
Checked for validity of licenses for liability insurance, BNDD, DEA, ABOM, and NPPES.

8. Background Checks

Here's how credentialing assistants use background checks:

Verified licenses ran medical malpractice background checks and gathered supporting documentation.
Assisted with conducting background checks for initial applications.

9. Medicaid

Here's how credentialing assistants use medicaid:

Assisted physician credentialing staff to update physician files*Provided research information and faxed all incoming physician licenses to state Medicaid office
Determine patient Medicaid and Medicare Eligibility.

10. Cactus

Here's how credentialing assistants use cactus:

Maintain current and accurate documentation in provider credentials files, Visual CACTUS provider database, and in integrated electronic files
Assisted with entering provider's identification number into Cactus.

11. Malpractice Insurance

Here's how credentialing assistants use malpractice insurance:

Conducted queries to ABMS for the verification of required board certification and verification of malpractice insurance.
Ensured that all providers in the network had current state licenses as well as updated malpractice insurance.

12. Health Plan

Here's how credentialing assistants use health plan:

Complete physician and Allied Health provider credentialing applications for facilities & enrollment in participating health plans.
Processed the CVO, malpractice, hospital, and health plan applications for all new providers joining the Medical Group.

13. Board Certification

Here's how credentialing assistants use board certification:

Verified and validated employment experience, education, licensure, residency and other training, specialty board certification or current eligibility.
Verified and tracked licensure, board certifications and clinical Performance Appraisal Reports expiration dates.

14. Administrative Tasks

Here's how credentialing assistants use administrative tasks:

Provided support to Credentialing Specialist in reference to administrative tasks.
Performed other administrative tasks to aid the credentialing department.

15. Provider Data

Here's how credentialing assistants use provider data:

Entered credentialing data into credentialing provider database.
Produced scheduled and adhoc reports from PO provider database and or Excel.

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List of credentialing assistant skills to add to your resume

The most important skills for a credentialing assistant resume and required skills for a credentialing assistant to have include:

Data Entry
Insurance Carriers
CAQH
Primary Source Verification
Health Professionals
NCQA
DEA
Background Checks
Medicaid
Cactus
Malpractice Insurance
Health Plan
Board Certification
Administrative Tasks
Provider Data

Provider Applications
CMS
Reappointment Applications
Medical Professionals
NPDB
Meeting Minutes
Federal Regulations
Practitioner Data
CME
Computer System
Medical License
Hospital Affiliations
NPI
Hippa
OIG

Processing Applications
PowerPoint
HR
Scheduling Appointments
URAC
Travel Arrangements
HMO
HIPAA
Clinical Privileges
Hospital Privileges
Office Equipment
Expense Reports
Committee Review
PPO

Updated January 8, 2025

Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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