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Credentialing specialist skills for your resume and career

Updated January 8, 2025

4 min read

Quoted expert

Elisha Blankson

Below we've compiled a list of the most critical credentialing specialist skills. We ranked the top skills for credentialing specialists based on the percentage of resumes they appeared on. For example, 9.8% of credentialing specialist resumes contained patients as a skill. Continue reading to find out what skills a credentialing specialist needs to be successful in the workplace.

15 credentialing specialist skills for your resume and career

1. Patients

Here's how credentialing specialists use patients:

Documented complaints registered by patients against doctors* Prepared packets for board meetings; reviewed and maintained applications and files for physician assistants
Maintain confidentiality of all information related to credentialing activities, medical staff administration and the treatment of patients.

2. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how credentialing specialists use customer service:

Provide excellent customer service by listening to concerns, troubleshooting problems and responding to organizational and individual needs.
Position also involved customer service, message distribution, and ancillary scheduling, preparation and referrals management.

3. 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 specialists use data entry:

Maintained credential database through ongoing data entry of practitioner updates with accuracy and in compliance of established integrity guidelines.
Maintained accurate provider data in the provider database and other applications through accurate data entry and verification as necessary.

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 specialists use primary source verification:

Performed primary source verification of physicians, allied health and other practitioners in accordance with departmental, accreditation and regulatory standards.
Coordinated all aspects of the credentialing and primary source verification process for practitioners, health care providers and health delivery organizations.

5. NCQA

Here's how credentialing specialists use ncqa:

Reinforced NCQA guidelines to assure efficient credentialing and move to delegated credentialing Designed and implement the credentialing software system-CACTUS.
Conducted initial and annual credentialing and re-credentialing delegation oversight audits in compliance with NCQA and ICE requirements and guidelines.

6. CAQH

Here's how credentialing specialists use caqh:

Enforced regulatory compliance and quality assurance by ensuring all provider information meets Massachusetts state guidelines when processing CAQH applications.
Collect and process significant amounts of verification and accreditation information using Cactus and CAQH ProView.

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7. Health Professionals

Here's how credentialing specialists use health professionals:

Coordinated follow up with physicians and allied health professionals to assure accuracy and timeliness of information submitted to carriers.
Initiated functions relative to initial credentialing and re-credentialing for physicians and Allied Health Professionals in Lexington and Central Kentucky.

8. Staff Bylaws

Here's how credentialing specialists use staff bylaws:

Process initial and re-enrollment applications for employed and contracted providers according to the Medical staff bylaws and credentialing policies.
Ensured compliance with Medical Staff Bylaws and regulatory requirements flagging any issues identified during the credentialing process.

9. 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 specialists use dea:

Detailed spreadsheet information verifying hospital privileges, malpractice insurance, - DEA verification.
Accessed various government websites for verification of DEA registration and board certifications.

10. Excellent Interpersonal

Here's how credentialing specialists use excellent interpersonal:

Possess strong client/goal orientation, and excellent interpersonal, communication and computer skills.
Maintained confidentiality of information and demonstrated excellent interpersonal, written, and verbal communication skills.

11. CMS

A Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.

Here's how credentialing specialists use cms:

Review application for completeness and accuracy of information using CMS approved procedures, guidelines and rules.
Researched CMS guidelines as needed to complete application credentialing process and to respond appropriately to providers.

12. Regulatory Agencies

A regulatory agency is a Public Benefit Corporation (PBC) that is responsible for supervising certain human activities and controlling them to some extent. They are set up in some areas such as hospitals, law firms, and governmental setup to regulate safety standards. They prevent undue and unjust abuse of power in these setups.

Here's how credentialing specialists use regulatory agencies:

Provided timely reports to practitioners, departmental chairmen, and committees regarding focused reviews to ensure compliance with all regulatory agencies.
Managed sensitive and confidential personal information for credentialing verification requirements with regulatory agencies, universities and hospitals.

13. Board Certification

Here's how credentialing specialists use board certification:

Maintained credentialing database to reflect accurate data, current board certification and updated licensing and certifications for all allied health practitioners.
Verify medical degrees through the National Student Clearinghouse for certifications, residency/training, board certifications, practice licenses and registrations.

14. Excellent Organizational

Here's how credentialing specialists use excellent organizational:

Combine excellent organizational skills with hands-on technical knowledge, superior memory for details and a strong work ethic.
Type 80wpm, ability to multi task in a fast paced environment and process excellent organizational skills.

15. HIPAA

Here's how credentialing specialists use hipaa:

Developed and implemented training and educational activities necessary to organizational requirements as required by HIPAA confidentiality policies.
Maintain strict confidentiality of employee and organizational information in accordance with HIPAA and State privacy regulations.

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What skills help Credentialing Specialists find jobs?

Tell us what job you are looking for, we’ll show you what skills employers want.

What type of skills will young credentialing specialists need?

Elisha Blankson

Program Director NCCU, Assistant Professor, North Carolina Central University

Graduates will need a skill set about the field in which they received training and additional skills useful to the job market. For example, with the changing demographics in the United States, extra skills in information technology and foreign languages will be a plus when entering the job market.

Do you want to know more?

List of credentialing specialist skills to add to your resume

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

Patients
Customer Service
Data Entry
Primary Source Verification
NCQA
CAQH
Health Professionals
Staff Bylaws
DEA
Excellent Interpersonal
CMS
Regulatory Agencies
Board Certification
Excellent Organizational
HIPAA
Health System

Work Ethic
Cactus
Provider Applications
Medicare
Medicaid
Commission Standards
Reappointment Applications
NPDB
Background Checks
JCAHO
Malpractice Insurance
Insurance Carriers
OIG
Provider Data
Practitioner Data
Healthcare Organizations

Provider Credentials
Hospital Privileges
Reappointment Process
Medical License
Certification Expirations
Process Applications
Physician Assistants
State Regulations
Practitioner Applications
NPI
CME
Malpractice Coverage
Drug Enforcement Administration
Committee Review
Telemedicine
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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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