The Importance of a Medical Credentialing Specialist
by Applied Medical Systems
A medical credentialing specialist works for a group practice, hospital, credentialing agency, or another healthcare organization to ensure that medical professionals are compliant with government credential standards. They are responsible for verifying the legitimacy of health care professionals with universities, licensing agencies, and certification groups.In addition, a medical credentialing specialist maintains a database of the training, education, licensing, and experience information of healthcare professionals and ensures that these professionals are adhering to government laws, department regulations, and staff policies. Medical credentialing specialists work in office environments and are unique because they play a vital role in the healthcare industry without working directly with patients.
Requirements for Medical Credentialing Specialists
The majority of medical credentialing specialists hold an associate’s degree in business administration or health care or have at least two years of work experience in a healthcare setting. They also have excellent interpersonal skills and are proficient in word processing and spreadsheet applications.
Why are Medical Credentialing Specialists Important?
With the assistance of medical credentialing specialists, medical organizations can ensure that they only hire healthcare professionals that are properly educated and trained. Without qualified healthcare professionals, medical organizations cannot provide patients with the high quality of care they deserve.In addition, medical credentialing can affiliate medical providers with a variety of insurance companies so that they can accept third party reimbursement. These days, being able to accept the insurance of potential patients is essential for the success of any medical organization. If potential patients find out that they cannot use their insurance policy to pay for medical services at a certain practice, they will find another provider that does accept their insurance. Since insurance plans are covering more treatments than they did in previous years, medical credentialing is more important than ever before.