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Top 10 Credentialing Specialist Certifications

This article provides a comprehensive overview of the top credentialing specialist certifications available and their key features.

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Brenna Goyette
Certified Professional Resume Writer, Career Expert

Published 17 min read

Certifications are important for credentialing specialists in the job market because they demonstrate that a specialist has the knowledge and skills necessary to perform their role effectively. Certifications also show potential employers that a credentialing specialist is up-to-date on industry standards, trends, and best practices. Having certifications can help a credentialing specialist stand out from other applicants when applying for jobs. In addition, certifications can increase an individual’s earning potential, as they may be able to negotiate higher salaries due to having credentials recognized by employers in the industry.

The purpose of this article is to review some of the top certifications for Credentialing Specialists and explain how they can help to advance a credentialing specialist's career.

What are Credentialing Specialist Certifications?

Credentialing specialist certification is a professional credential that demonstrates an individual's knowledge and expertise in the area of healthcare credentialing. Healthcare credentialing is the process of verifying and validating the qualifications, experience, education, licensure, and other credentials of healthcare practitioners. Credentialing specialists are responsible for ensuring that all healthcare providers are properly qualified to provide services to patients.

Credentialing specialist certification can be obtained through various organizations such as the American Medical Association (AMA) or National Board for Certification of Credentialing Specialists (NBCCS). These certifications typically require successful completion of an exam and continuing education credits. This certification provides evidence that a credentialing specialist has taken the necessary steps to demonstrate their knowledge and proficiency in this field.

Having a credentialing specialist certification can be beneficial for those seeking employment in this field as it will set them apart from other applicants who may not have this type of professional recognition. It can also help employers ensure they are hiring qualified professionals who have demonstrated their knowledge in this area. Additionally, having a credentialing specialist certification may open up opportunities for advancement within the organization or increase job security.

Pro Tip: To become a credentialing specialist, consider taking a certification course that covers the fundamentals of credentialing and medical staff services. This will provide you with the knowledge and skills needed to become a successful credentialing specialist and increase your chances of finding employment in the field.

Related: What does a Credentialing Specialist do?

Top 10 Credentialing Specialist Certifications

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

1. Certified Professional Credentialing Specialist (CPCS)

Certified Professional Credentialing Specialist (CPCS) is a credential offered by the National Association of Professional Credentialing Specialists (NAPCS). It is designed to recognize individuals who have achieved a high level of knowledge and expertise in the field of professional credentialing. The CPCS credential is intended to demonstrate that an individual has mastered the skills necessary to effectively manage the credentialing process for healthcare providers, organizations, and other entities.

The CPCS exam consists of 150 multiple-choice questions covering topics such as accreditation standards, credentialing processes, verification methods, and regulations related to healthcare credentialing. To be eligible for the exam, applicants must have at least two years of experience in a professional credentialing role or have completed an NAPCS-approved course in professional credentialing.

The cost of taking the CPCS exam varies depending on whether you are a member or non-member of NAPCS. For members, the cost is $225; non-members pay $325. The exam can be taken at any approved testing center around the world. Once you have registered for the exam and paid the fee, you will receive an email with instructions on how to schedule your test date and time.

It typically takes about three weeks to receive your results after taking the CPCS exam. If you pass, you will be awarded your Certified Professional Credentialing Specialist designation and will receive a certificate from NAPCS verifying your achievement.

2. Certified Healthcare Credentialing Specialist (CHCS)

Certified Healthcare Credentialing Specialist (CHCS) is a certification offered by the National Association of Medical Staff Services (NAMSS). It is designed to recognize professionals who have demonstrated expertise in the field of healthcare credentialing. The CHCS certification is intended to demonstrate that an individual has a comprehensive understanding of the credentialing process, including its legal and regulatory aspects.

The CHCS certification requires applicants to have at least two years of experience in healthcare credentialing or related fields and pass a comprehensive exam. The exam consists of 150 multiple-choice questions covering topics such as healthcare regulations, credentialing processes, data accuracy, and customer service. Candidates must also complete an online application and submit official transcripts from their educational institutions.

It typically takes six months to one year to complete the requirements for the CHCS certification. Candidates must complete the application process, obtain any necessary transcripts, study for and take the exam, and receive their results before they can be certified.

The cost of obtaining the CHCS certification varies depending on whether or not you are a NAMSS member. For non-members, it costs $400 for initial registration and $325 for each recertification every three years thereafter. For members, it costs $350 for initial registration and $275 for each recertification every three years thereafter.

3. Certified Medical Credentialing Specialist (CMCS)

A Certified Medical Credentialing Specialist (CMCS) is a professional who specializes in the credentialing of healthcare providers. The CMCS credential is awarded to individuals who have demonstrated a high level of knowledge and expertise in the field of medical credentialing. The CMCS certification is offered through the National Association of Medical Staff Services (NAMSS).

To become certified, an individual must meet certain eligibility requirements, including having at least three years of experience in medical staff services or healthcare administration and passing an exam administered by NAMSS. It typically takes 6-8 weeks to complete the application process and receive your certification.

The cost for the CMCS examination is $425 for NAMSS members and $525 for non-members. In addition, there are fees associated with obtaining the necessary documentation required to apply for the certification. These fees may vary depending on where you live and what type of documentation you need to provide.

4. Certified Provider Credentialing Specialist (CPCS-P)

Certified Provider Credentialing Specialist (CPCS-P) is a professional certification that demonstrates expertise in the field of provider credentialing. It is designed to recognize individuals who have mastered the skills and knowledge required to effectively manage the provider credentialing process. The CPCS-P certification is offered by the National Association of Professional Credentialing Specialists (NAPCS).

To become certified, applicants must pass an exam that tests their knowledge and understanding of the credentialing process. The exam consists of 150 multiple choice questions covering topics such as provider data management, credentialing regulations, and quality assurance. Applicants must also submit three letters of recommendation from current or former employers attesting to their experience in the field.

The cost for the CPCS-P certification exam is $375 USD, which includes a one-time application fee of $75 USD and a $300 USD exam fee. The exam can be taken at any Prometric Testing Center located throughout the United States or online through NAPCS’s website. It typically takes about four weeks for applicants to receive their results after taking the exam.

Once certified, professionals are required to complete 30 continuing education units every two years in order to maintain their certification status. This can be done through attending conferences, seminars, workshops, or other approved activities related to provider credentialing.

5. Certified Professional Credentialing Manager (CPCM)

Certified Professional Credentialing Manager (CPCM) is a certification program offered by the National Association of Credentialing Professionals (NACPRO). It is designed to recognize individuals who have demonstrated expertise in credentialing, privileging and provider enrollment.

The CPCM certification requires applicants to have at least five years of experience in credentialing or related fields. To obtain the certification, applicants must pass an exam that consists of 150 multiple-choice questions covering topics such as credentialing processes and procedures, privileging, provider enrollment, healthcare regulations and quality assurance. The exam takes approximately three hours to complete.

To register for the CPCM exam, applicants must submit an application form and pay a registration fee of $395. Once registered, applicants will receive an email with instructions on how to access the online practice exams and study materials. After passing the exam, applicants will receive their CPCM certification within four weeks.

The cost of obtaining the CPCM certification varies depending on whether you are a member or non-member of NACPRO. Members can apply for discounted rates when registering for the exam ($295) and renewing their certification every two years ($95). Non-members pay full price for both registration ($395) and renewal ($195).

6. Certified Healthcare Quality and Compliance Specialist (CHQCS)

Certified Healthcare Quality and Compliance Specialist (CHQCS) is a certification designed to recognize individuals who have demonstrated knowledge and expertise in healthcare quality and compliance. The CHQCS certification is offered through the American Association for Healthcare Quality (AAHQ).

The CHQCS certification requires applicants to have at least three years of experience in the field of healthcare quality or compliance, as well as a bachelor’s degree from an accredited institution. Applicants must also pass an exam that covers topics such as healthcare regulations, quality improvement processes, patient safety, risk management, and data analysis.

It typically takes about six months to complete the application process and prepare for the exam. During this time, applicants should review study materials provided by AAHQ and take practice tests to ensure they are prepared for the exam.

The cost of becoming certified as a CHQCS varies depending on whether you are an AAHQ member or non-member. For members, it costs $450 while non-members pay $550. This fee includes both the application fee and the cost of taking the exam.

7. Certified Medical Practice Manager (CMPM)

Certified Medical Practice Manager (CMPM) is a professional certification program designed to recognize and promote the knowledge and skills of medical practice managers. The CMPM program is offered by the American Association of Medical Practice Executives (AAMPE). It is a comprehensive program that covers all aspects of medical practice management, including finance, operations, human resources, information technology, marketing, compliance and risk management.

The CMPM certification requires applicants to pass an exam that tests their knowledge and understanding of medical practice management. The exam consists of multiple-choice questions and takes approximately two hours to complete. Applicants must also have a minimum of three years' experience in managing a healthcare organization or department in order to be eligible for the certification.

The cost for the CMPM certification is $395 for AAMPE members and $495 for non-members. This fee includes the cost of the exam, study materials, and access to online resources. Once an applicant has successfully completed the exam, they will receive their certificate within four weeks.

The CMPM certification must be renewed every three years by taking continuing education courses or passing an updated version of the exam. Renewal fees are $95 for AAMPE members and $195 for non-members.

8. Certified Medical Office Administrator (CMOA)

Certified Medical Office Administrator (CMOA) is a certification program designed to recognize professionals who have demonstrated the knowledge, skills, and abilities necessary to effectively manage medical office operations. The CMOA certification is offered by the National Healthcareer Association (NHA).

To become certified as a CMOA, individuals must meet certain education and experience requirements, pass an exam, and pay a fee. To qualify for the exam, applicants must have at least one year of full-time experience in a medical office setting or three years of part-time experience in a medical office setting within the last five years. Applicants must also hold either an associate degree in healthcare or business administration or an equivalent combination of education and experience.

The CMOA exam consists of 150 multiple choice questions covering topics such as medical terminology, coding systems, reimbursement methods, patient privacy regulations, practice management systems, and human resource management. The exam takes approximately two hours to complete and costs $125. Upon successful completion of the exam, individuals will be awarded their CMOA certification which is valid for three years.

9. Certified Professional in Healthcare Quality and Compliance Management (CPHQCM)

Certified Professional in Healthcare Quality and Compliance Management (CPHQCM) is a professional certification program offered by the National Association for Healthcare Quality (NAHQ). It is designed to recognize individuals who have demonstrated expertise in healthcare quality and compliance management. The CPHQCM credential is sought after by healthcare professionals who want to demonstrate their commitment to excellence in this field.

The CPHQCM certification requires candidates to pass an exam that tests knowledge of healthcare quality, compliance, and risk management principles. Candidates must also have at least two years of experience in the field. To maintain their certification, they must complete continuing education credits every three years.

The CPHQCM exam is offered twice per year, typically in the spring and fall months. The exam consists of 150 multiple-choice questions that must be completed within three hours. Candidates must score at least 70% on the exam to pass.

The cost of taking the CPHQCM exam varies depending on your NAHQ membership status. For non-members, the cost is $450; for members, it is $395; and for student members, it is $350.

Once you have passed the CPHQCM exam, you will receive your certification within 6-8 weeks from NAHQ.

10. Certified Professional in Healthcare Risk Management (CPHRM).

Certified Professional in Healthcare Risk Management (CPHRM) is a professional certification program offered by the American Society for Healthcare Risk Management (ASHRM). The CPHRM certification is designed to recognize healthcare professionals who demonstrate a high level of knowledge and skill in the field of healthcare risk management.

The CPHRM program consists of two parts: an online exam and a clinical practice experience. The online exam covers topics such as legal and regulatory issues, patient safety, quality improvement, risk assessment and mitigation, and claims management. The clinical practice experience requires applicants to demonstrate their proficiency in applying risk management concepts in real-world settings.

To be eligible for the CPHRM certification, applicants must have at least five years of experience in healthcare risk management or related fields, including at least three years of direct patient care or healthcare administration experience. Applicants must also complete continuing education credits every two years to maintain their certification status.

The cost of obtaining the CPHRM certification varies depending on the applicant’s background and experience. Generally, it costs between $500-$1,000 to register for the exam and complete all associated requirements. In addition, some states may require additional fees or other requirements before granting a license to practice as a Certified Professional in Healthcare Risk Management (CPHRM).

Do You Really Need a Credentialing Specialist Certificate?

Whether or not you need a Credentialing Specialist Certificate depends on your career goals. If you are looking to become a credentialing specialist, then obtaining a certificate may help you stand out from other job applicants and demonstrate that you have the necessary knowledge and skills in the field. A certificate could also be beneficial if you wish to advance in the credentialing specialist field by pursuing additional training to enhance your existing knowledge and skills.

On the other hand, if you are already working as a credentialing specialist and do not plan to pursue additional training or career advancement opportunities, then obtaining a Credentialing Specialist Certificate might not be necessary. Even so, it can still be beneficial to have the certificate as proof of your expertise in the field, which could help when applying for promotions or lateral moves within your organization.

Ultimately, whether or not you need a Credentialing Specialist Certificate comes down to your individual career goals and ambitions. If having the certificate will help you achieve those goals, then it is definitely worth considering.

Related: Credentialing Specialist Resume Examples

FAQs About Credentialing Specialist Certifications

1. What is a credentialing specialist certification?

Answer: A credentialing specialist certification is a professional qualification that demonstrates expertise in the field of credentialing, which involves verifying the qualifications of professionals such as doctors and nurses.

2. How do I become certified as a credentialing specialist?

Answer: To become certified as a credentialing specialist, you must complete an accredited program that covers topics such as cost containment, risk management, provider relations, and healthcare regulations. You will also need to pass an exam administered by a professional organization or educational institution.

3. What benefits does becoming certified as a credentialing specialist offer?

Answer: Becoming certified as a credentialing specialist can help you stand out from other job applicants and demonstrate your knowledge and skills in the field of healthcare credentialing. It can also open up new career opportunities and provide potential salary increases.

4. How long does it take to become certified as a credentialing specialist?

Answer: The length of time required to become certified as a credentialing specialist varies depending on the specific program you choose to pursue. Generally speaking, most programs require between six months and two years of study in order to complete all necessary requirements for certification.

5. Are there any continuing education requirements for maintaining my certification?

Answer: Yes, most organizations that offer credentials require their certificate holders to participate in regular continuing education activities in order to maintain their certifications. This may include attending conferences or workshops, taking classes online or through an accredited institution, or completing self-study courses related to the field of healthcare credentialing.