How To Become A Credentialing Specialist: What It Is and Career Path

What is a credentialing specialist and how to become one

Updated January 8, 2025

4 min read

A credentialing specialist verifies the qualifications and credentials of individuals or organizations seeking employment or membership. They ensure the necessary documents, licenses, and certifications are in place and up to date. This includes conducting background checks, verifying experience, and reviewing references. Credentialing specialists also maintain records to certify compliance. They work with healthcare providers, insurance companies, educational institutions, and organizations to verify that only qualified individuals gain access to certain privileges or services.

ScoreCredentialing SpecialistUS Average

Salary

3.2

Avg. Salary $40,899

Avg. Salary $59,228

Stability Level

7.2

Growth Rate -8%

Growth Rate 0.3%

Diversity

3.2

Race

American Indian and Alaska Native 0.37%

Asian 3.77%

Black or African American 9.57%

Hispanic or Latino 11.96%

Unknown 3.77%

White 70.56%

Gender

female 85.51%

male 14.49%

Age - 51

Race

American Indian and Alaska Native 3.00%

Asian 7.00%

Black or African American 14.00%

Hispanic or Latino 19.00%

White 57.00%

Gender

female 47.00%

male 53.00%

Age - 51

Stress Level

7.2

Stress level is high

7.1 - high

Complexity Level

4.7

Complexity Level is intermediate

7 - challenging

Work Life Balance

9.3

Work Life balance is excellent

6.4 - fair

What are the pros and cons of being a Credentialing Specialist?

Pros

Stable and in-demand job
Opportunity for advancement
Ability to work remotely
Competitive salary and benefits
Potential for flexible scheduling

Cons

Significant responsibility and liability
Tight deadlines and high volume of work
Limited interaction with patients
May require significant overtime or weekend work
Can be emotionally taxing when dealing with disciplinary actions or denials of privileges

Newest jobs for Credentialing Specialist in Ashburn, VA

Receive alerts for the newest job postings.

Key steps to become a credentialing specialist

Explore credentialing specialist education requirements

Most common credentialing specialist degrees

Bachelor's

47.3 %

Associate

23.1 %

High School Diploma

11.1 %

Start to develop specific credentialing specialist skills

Skills	Percentages
Patients	9.79%
Customer Service	8.29%
Data Entry	6.46%
Primary Source Verification	5.19%
NCQA	4.70%

Complete relevant credentialing specialist training and internships

Accountants spend an average of Less than 1 month on post-employment, on-the-job training. New credentialing specialists learn the skills and techniques required for their job and employer during this time. The chart below shows how long it takes to gain competency as a credentialing specialist based on U.S. Bureau of Labor Statistics data and data from real credentialing specialist resumes.

Gain additional credentialing specialist certifications

Credentialing specialist certifications can show employers you have a baseline of knowledge expected for the position. Certifications can also make you a more competitive candidate. Even if employers don't require a specific credentialing specialist certification, having one may help you stand out relative to other applicants.

The most common certifications for credentialing specialists include Certified Billing and Coding Specialist (CBCS) and Certified Provider Credentialing Specialist (CPCS).

More About Certifications

Research credentialing specialist duties and responsibilities

Establish rapport with all PCP offices, hospital personnel, and manage care representatives.
Manage and administer the programs CME accredit education programs/Conferences.
Ensure enrollment and participation with all organization contract managed care plans and perform Medicaid/Medicare provider enrollment.
Process and manage all requests and applications for CME certification and supervise activities relate to credentialing process.

Prepare your credentialing specialist resume

When your background is strong enough, you can start writing your credentialing specialist resume.

You can use Zippia's AI resume builder to make the resume writing process easier while also making sure that you include key information that hiring managers expect to see on a credentialing specialist resume. You'll find resume tips and examples of skills, responsibilities, and summaries, all provided by Zippi, your career sidekick.

Choose From 10+ Customizable Credentialing Specialist Resume templates

Build a professional Credentialing Specialist resume in minutes. Browse through our resume examples to identify the best way to word your resume. Then choose from 10+ resume templates to create your Credentialing Specialist resume.