Article

Top 11 Credentialing Coordinator Certifications

This article outlines the top credentialing coordinator certifications and provides an overview of the qualifications, benefits, and requirements for each.

Photo of Brenna Goyette
Brenna Goyette
Certified Professional Resume Writer, Career Expert

Published 19 min read

Certifications are an important part of a credentialing coordinator’s job market profile. Certifications demonstrate to potential employers that the credentialing coordinator has the necessary knowledge and skills to effectively manage the credentialing process. They also show that the individual is committed to staying abreast of changes in the field and continuing their education, which can make them more attractive to employers. In addition, certifications from professional organizations can help credentialing coordinators stand out from other applicants and be seen as more credible and knowledgeable in their field.

The purpose of this article is to provide an overview of the top certifications for Credentialing Coordinators and explain how they can help advance their career.

What are Credentialing Coordinator Certifications?

Credentialing coordinator certification is a type of professional credential that recognizes individuals who have demonstrated a level of knowledge and skill related to the credentialing process. Credentialing coordinators are responsible for verifying that healthcare providers meet the necessary qualifications and standards for providing care in their respective organizations. This includes verifying licensure, education, training, and other applicable credentials.

Credentialing coordinator certification is offered by various organizations, such as the National Alliance of Certified Credentialing Specialists (NACCS) and the American Association of Medical Staff Services (AAMSS). The certification is designed to recognize professionals who have achieved a high level of proficiency in the field of credentialing. It also acts as an assurance to employers that they are hiring qualified individuals to handle their credentialing needs.

By obtaining credentialing coordinator certification, individuals demonstrate their commitment to excellence in the field. This can help them stand out amongst their peers when applying for jobs or promotions. Additionally, having this certification may make them eligible for higher pay or more responsibility within their organization. Finally, having this certification may provide access to exclusive networking opportunities and resources that can help further career growth and development.

Pro Tip: Make sure to research the credentialing coordinator certification programs available and look for programs that provide thorough training on the latest industry trends and best practices. Additionally, look for certifications that are accredited by a national organization, as this will help ensure that you have received the highest quality of training.

Related: What does a Credentialing Coordinator do?

Top 11 Credentialing Coordinator Certifications

Here’s our list of the best certifications available to Credentialing Coordinators today.

1. Certified Professional Credentialing Specialist (CPCS)

Certified Professional Credentialing Specialist (CPCS) is a professional certification program offered by the National Association of Credentialing Specialists (NACS). The CPCS program provides credentialing professionals with specialized knowledge and skills to help them effectively manage the credentialing process. It also helps employers ensure that their employees meet the highest standards of professional competence.

The CPCS program consists of two levels: Level I and Level II. To become certified at either level, an individual must complete a series of courses and pass an exam. The Level I course focuses on fundamentals such as ethics, credentialing processes, and data management. The Level II course covers advanced topics such as risk management, quality assurance, and legal issues related to credentialing.

It typically takes between 6-12 months to complete the CPCS program depending on how much time an individual has available for studying and taking exams. In order to get certified, individuals must successfully complete all required courses and pass both the written exam and the practical exam.

The cost for the CPCS program varies depending on which level you are pursuing. Generally speaking, it costs around $1,000-$2,000 for both levels combined.

2. Certified Medical Staff Credentialing Specialist (CMSS)

Certified Medical Staff Credentialing Specialist (CMSS) is a credential offered by the National Association of Medical Staff Services (NAMSS). This certification is designed for professionals who are responsible for managing and coordinating the medical staff credentialing process. The CMSS credential demonstrates that an individual has the knowledge and skills necessary to effectively manage the medical staff credentialing process.

The CMSS exam consists of 150 multiple-choice questions, covering topics such as medical staff organization, primary source verification, privileging and peer review, regulatory compliance, and quality improvement. To become certified, individuals must pass the exam with a score of at least 70%.

The cost to take the CMSS exam is $395 for NAMSS members and $495 for non-members. It typically takes two to three months to prepare for the exam. To get started on your journey towards becoming a Certified Medical Staff Credentialing Specialist, you should first become a member of NAMSS and register for the exam. After registering, you will receive access to study materials such as practice exams and online courses that can help you prepare for the exam.

3. Certified Credentialing and Provider Enrollment Professional (CCPEP)

Certified Credentialing and Provider Enrollment Professional (CCPEP) is a certification offered by the National Association of Credentialing Professionals (NACP). The CCPEP certification is designed for professionals who are responsible for the credentialing, privileging, and enrollment of healthcare providers. It is intended to provide recognition of those who have achieved a level of expertise in these areas.

The CCPEP certification requires applicants to pass an exam that covers topics such as provider enrollment and credentialing processes, data integrity, compliance with federal regulations, and risk management. The exam consists of 150 multiple-choice questions that must be completed within two hours.

To be eligible to take the CCPEP exam, applicants must have at least three years of experience in provider enrollment or credentialing activities within the last five years. Applicants are also required to submit proof of completion of at least 24 hours of continuing education in provider enrollment or credentialing activities within the past two years.

The cost to take the CCPEP exam is $375 for NACP members and $475 for non-members. After passing the exam, applicants will receive their CCPEP certification which is valid for three years before needing to be renewed.

4. Certified Healthcare Credentialing and Compliance Professional (CHCP)

Certified Healthcare Credentialing and Compliance Professional (CHCP) is a certification program that recognizes the knowledge and skills of professionals who are responsible for credentialing healthcare providers, managing compliance, and ensuring quality patient care. CHCP certification is offered through the National Association of Healthcare Compliance Professionals (NAHCP). The certification is designed to ensure that healthcare organizations have qualified professionals to manage their credentialing and compliance programs.

The CHCP certification program consists of three parts: an online course, a written exam, and a practical application assessment. The online course takes approximately 10 hours to complete and covers topics such as understanding healthcare regulations, developing effective credentialing processes, and managing compliance programs. After completing the course, students must pass a written exam which tests their knowledge of the material covered in the course. Finally, students must complete a practical application assessment which evaluates their ability to apply what they have learned in real-world scenarios.

To become certified as a CHCP, applicants must meet certain eligibility requirements including having at least two years of experience working in healthcare credentialing or compliance management. Additionally, applicants must pay an initial application fee of $150 plus any applicable taxes or fees. Once certified, CHCPs must renew their certification every two years by paying an annual renewal fee of $100 plus applicable taxes or fees.

5. Certified Provider Network Administrator (CPNA)

Certified Provider Network Administrator (CPNA) is a certification program offered by the American Board of Information Technology (ABIT). The CPNA certification is designed to recognize IT professionals who have demonstrated mastery in the areas of network administration, security, and management.

The CPNA exam consists of 120 multiple-choice questions that cover topics such as network architecture, routing protocols, security protocols, system management tools, and troubleshooting techniques. The exam takes approximately four hours to complete and costs $395 USD.

To become certified as a CPNA, you must first meet certain eligibility requirements. You must be at least 18 years old and have a minimum of two years’ experience in the field of information technology or related fields. You must also have completed at least one year of college-level coursework in an IT-related subject or hold an associate degree in an IT-related field from an accredited institution.

Once you meet these requirements, you can register for the CPNA exam through ABIT's website. Once registered, you will receive instructions on how to access the online testing platform and take the exam. Upon successful completion of the exam, you will receive your official CPNA certification.

6. American Health Information Management Association (AHIMA) Credentialing Certificate Program

The American Health Information Management Association (AHIMA) Credentialing Certificate Program is a program designed to recognize and validate the knowledge, skills, and abilities of professionals in the health information management field. It is designed to help healthcare organizations improve patient safety and quality of care by recognizing those who have demonstrated their commitment to excellence in their profession.

The program consists of three levels: Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), and Registered Health Information Administrator (RHIA). Each level requires applicants to pass an exam that covers topics such as medical terminology, coding systems, reimbursement systems, privacy and security regulations, healthcare data analysis, and more.

It typically takes between six months and one year to complete the program. The amount of time required depends on the individual's experience level and dedication to studying for the exams.

To get started with the AHIMA Credentialing Certificate Program, individuals must first become a member of AHIMA by registering online or submitting an application form. After becoming a member, individuals can then purchase study materials from AHIMA or other approved vendors. They must also register for each exam they plan to take through AHIMA's website.

The cost of the program varies depending on which exams are taken and where they are taken from. Each exam costs approximately $300-$400 USD plus any additional fees associated with taking it at an approved testing center. Additionally, there may be additional fees associated with purchasing study materials or joining AHIMA as a member.

7. National Association of Medical Staff Services (NAMSS) Certification Program

The National Association of Medical Staff Services (NAMSS) Certification Program is a voluntary certification program that recognizes medical staff services professionals who have demonstrated knowledge and proficiency in the field. It is designed to promote excellence in medical staff services by setting standards for professional practice and providing recognition to those who meet these standards.

To become certified, applicants must demonstrate their knowledge and experience in the profession by passing an exam. The exam consists of questions related to the core competencies of medical staff services, including credentialing, privileging, accreditation, regulatory compliance, and quality improvement. The exam is administered twice a year at designated testing centers throughout the United States.

The cost of the NAMSS Certification Program varies depending on whether you are a member or non-member of NAMSS. For members, the cost is $325; for non-members, it is $425. In addition to the exam fee, there is an application fee of $50 for both members and non-members.

The time it takes to get certified depends on how quickly you can prepare for the exam. It typically takes three months or more to study for the exam and complete all necessary paperwork. After submitting your application and passing the exam, you will receive your certification within 4-6 weeks.

8. American Academy of Professional Coders (AAPC) Medical Coding Certification

The American Academy of Professional Coders (AAPC) Medical Coding Certification is a professional certification program designed to help coders demonstrate their knowledge and skills in medical coding. This certification is recognized nationally by employers, insurance companies, and other organizations as a standard for quality coding.

It typically takes about 6-12 months to complete the AAPC Medical Coding Certification program. The program includes both online coursework and an exam that must be passed in order to receive the certification. The online coursework covers topics such as anatomy and physiology, medical terminology, ICD-10 coding, CPT coding, HCPCS coding, modifiers, reimbursement methodologies, compliance regulations, auditing techniques and more.

In order to qualify for the AAPC Medical Coding Certification program you must have at least two years of experience in medical coding or be enrolled in an accredited medical coding training program. You will also need to pass a background check before being accepted into the program.

The cost of the AAPC Medical Coding Certification program varies depending on your location and whether you are taking it online or in person. Generally speaking, it costs around $400-$600 for the exam fee alone. Additional costs may include textbooks or other materials needed for the coursework.

9. National Commission for Certifying Agencies (NCCA) Accreditation

The National Commission for Certifying Agencies (NCCA) is an independent accreditation body that sets standards and grants accreditation to certifying organizations. The NCCA accreditation process ensures that certifying organizations have appropriate processes in place to evaluate the knowledge, skills, and abilities of their certified professionals. This includes ensuring that the organization’s certification program meets or exceeds industry standards for quality, validity, reliability, fairness, and consistency.

It typically takes 6-12 months for an organization to go through the NCCA accreditation process. The process begins with a self-assessment by the organization of its certification program against the NCCA Standards for Accreditation. Once complete, the organization submits an application to the NCCA along with supporting documentation such as policies and procedures manuals and job analysis data. The NCCA then reviews all materials submitted to determine if they meet its standards. If accepted, a site visit is scheduled during which a team of assessors visits the organization’s facility to verify that it meets all requirements set forth in the NCCA Standards for Accreditation. After this visit, a final report is submitted to the NCCA Board of Commissioners who will then make a decision regarding whether or not to grant accreditation.

The cost of obtaining NCCA accreditation varies depending on factors such as size of staff and number of programs offered by an organization. Generally speaking, however, it can cost anywhere from $2,000-$15,000 USD depending on these factors as well as additional fees associated with travel costs for assessors if required.

10. American College of Physician Executives (ACPE) Physician Executive Certification

The American College of Physician Executives (ACPE) Physician Executive Certification is a professional certification program for physicians who are interested in pursuing leadership roles in healthcare organizations. This certification is designed to demonstrate the knowledge and skills required for successful physician executive practice.

To become certified, applicants must meet the following requirements:

- Have an unrestricted medical license in good standing

- Have at least three years of experience as a practicing physician or two years of experience as a physician executive

- Possess a master's degree or higher from an accredited institution

- Complete the ACPE Physician Executive Certification Program, which includes both online and onsite learning components.

The ACPE Physician Executive Certification Program takes approximately 18 months to complete. It consists of four courses that cover topics such as healthcare finance, healthcare policy and law, organizational management, and strategic planning. Each course is completed online with onsite workshops held throughout the year. The cost of the program depends on the number of courses taken and ranges from $3,000 to $5,000.

11. American Health Care Association’s Quality Assurance Certification Program

The American Health Care Association (AHCA) Quality Assurance Certification Program is a voluntary program that provides recognition of health care organizations’ commitment to providing quality care and services. The program is designed to help organizations demonstrate their commitment to quality and patient safety, while also ensuring compliance with applicable regulations and standards.

The Quality Assurance Certification Program requires organizations to complete an extensive self-assessment process that includes the review of policies, procedures, and practices related to quality improvement, patient safety, and regulatory compliance. Organizations must also submit documentation of their performance in these areas for review by AHCA staff. Upon successful completion of the assessment process, organizations will receive a certificate from AHCA recognizing their commitment to quality care.

It typically takes between 6-12 months for an organization to complete the Quality Assurance Certification Program. During this time, organizations are required to develop or update policies and procedures related to quality assurance and patient safety; conduct internal audits; implement corrective action plans; and submit documentation of their performance for review by AHCA staff.

Organizations interested in obtaining AHCA Quality Assurance Certification can contact the organization directly for more information on how to get started with the program.

The cost of the Quality Assurance Certification Program depends on the size of the organization applying for certification. Generally, fees range from $2,000-$3,500 per facility/location.

Do You Really Need a Credentialing Coordinator Certificate?

No, you do not need a credentialing coordinator certificate to become a credentialing coordinator. However, having a credentialing coordinator certificate can be beneficial in several ways.

First, it demonstrates to potential employers that you have the knowledge and skills necessary to successfully perform the duties of a credentialing coordinator. Earning a credentialing coordinator certificate shows that you understand the nuances of this role, such as verifying credentials, handling data entry and processing applications. It also indicates that you possess the critical thinking and problem-solving skills required for the job.

Second, having a credentialing coordinator certificate may give you an edge over other applicants who are competing for the same job. Employers want to hire people who have gone above and beyond in their education and training, so having a certificate will demonstrate your commitment to your chosen career path.

Finally, having a credentialing coordinator certificate can open up new opportunities in your career as well as offer greater job security. The additional knowledge and experience gained from earning this type of certification can help you move up within an organization or transition into other roles within the health care industry that require similar skill sets.

In conclusion, although it is not required to become a credentialing coordinator, having a credentialing coordinator certificate can be beneficial in many ways when seeking employment or advancing in this field.

Related: Credentialing Coordinator Resume Examples

FAQs About Credentialing Coordinator Certifications

Q1. What is a Credentialing Coordinator Certification?

A1. A Credentialing Coordinator Certification is a professional certification that demonstrates an individual’s knowledge and expertise in the field of credentialing and provider enrollment. It is designed for those who work in medical facilities or health insurance organizations and are responsible for the review, verification, and maintenance of provider credentials.

Q2. How do I become certified as a Credentialing Coordinator?

A2. To become certified as a Credentialing Coordinator, you will need to complete an accredited program or course that covers the fundamentals of credentialing and provider enrollment, followed by passing the Certified Credentialing Coordinator (CCC) exam administered by the National Association of Medical Staff Services (NAMSS).

Q3. How long does it take to become certified as a Credentialing Coordinator?

A3. It typically takes between 8-12 months to complete all necessary coursework and training required for certification as a Credentialing Coordinator.

Q4. What type of jobs can I get with my Credentialing Coordinator Certification?

A4. With your Credentialing Coordinator Certification, you can pursue positions such as Provider Enrollment Specialist, Verification Analyst, Medical Records Technician, or even Manager of Provider Relations in medical facilities or health insurance organizations.

Q5. How long does my certification last?

A5. Your certification is valid for three years from the date it was issued, after which time you must renew it by completing continuing education courses approved by NAMSS and passing the renewal exam every three years to maintain your Certified Credentialing Coordinator status.