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Top 11 Provider Relations Representative Certifications

This article will provide an overview of the top certifications available for provider relations representatives, helping them stay up-to-date on the latest industry standards and trends.

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Brenna Goyette
Certified Professional Resume Writer, Career Expert

Published 17 min read

Certifications for a provider relations representative can be an important asset in the job market. Certifications demonstrate expertise and knowledge in the field, and can make a job applicant stand out among other candidates. They also provide proof that a provider relations representative has the necessary skills to work with healthcare providers, insurance companies, and other entities that they may interact with on a daily basis. Certification is also beneficial as it allows potential employers to know that the individual is up-to-date on industry practices and standards. Additionally, certifications often come with continuing education requirements which help keep provider relations representatives up-to-date on any changes or developments in the field.

The purpose of this article is to review and explain the top certifications for Provider Relations Representatives and how they can benefit their career.

What are Provider Relations Representative Certifications?

Provider Relations Representative Certification is a certification program that is designed to help individuals develop the skills and knowledge they need to effectively represent healthcare providers in their interactions with payers. This certification provides individuals with an understanding of the provider relations process, including how to establish and maintain relationships with payers, negotiate contracts, and manage appeals. Furthermore, this certification can help individuals gain a better understanding of the healthcare industry as a whole, including regulations and compliance. Having this knowledge can help ensure that providers are getting the best reimbursement for their services. Additionally, having this certification can demonstrate to employers that an individual has the necessary skills to effectively handle provider relations tasks.

Pro Tip: When considering certification for a Provider Relations Representative, look for programs that offer comprehensive training and testing in areas such as customer service, communication, billing and reimbursement, healthcare regulations, and data analysis. Additionally, check if the program offers continuing education opportunities to keep up with the latest industry trends.

Related: What does a Provider Relations Representative do?

Top 11 Provider Relations Representative Certifications

Here’s our list of the best certifications available to Provider Relations Representatives today.

1. Certified Provider Relations Representative (CPRR)

A Certified Provider Relations Representative (CPRR) is a professional designation that recognizes individuals who have demonstrated expertise in the field of provider relations. The CPRR designation is awarded by the National Association of Provider Relations Professionals (NAPRP) and is considered an industry standard for provider relations professionals.

The certification process consists of passing a comprehensive written exam, which covers topics such as provider relations strategies, contract negotiation, reimbursement models, and regulatory compliance. The exam typically takes three to four hours to complete and can be taken at any NAPRP-approved testing center.

In order to be eligible for the CPRR certification, applicants must have at least two years of experience in provider relations or a related field. Additionally, applicants must pay a fee of $150 for the application process and $250 for the exam.

Once certified, CPRRs are required to obtain continuing education credits every two years in order to maintain their certification status.

2. Certified Healthcare Provider Relations Professional (CHPRP)

Certified Healthcare Provider Relations Professional (CHPRP) is a certification program offered by the American Association of Healthcare Administrative Management (AAHAM). The CHPRP credential is designed to recognize individuals who have achieved a high level of expertise in healthcare provider relations.

The CHPRP program requires applicants to have at least three years of experience in healthcare provider relations and have completed a minimum of 45 hours of continuing education in the field. Applicants must also pass an exam that covers topics such as patient access, customer service, reimbursement, compliance, and other related topics.

The exam can be taken online or at designated testing centers. It takes approximately 3-4 hours to complete the exam and costs $350 for AAHAM members and $450 for non-members.

Once you pass the exam, you will receive your certification within four weeks. The CHPRP credential is valid for three years and can be renewed by completing 45 additional hours of continuing education credits in healthcare provider relations.

3. Certified Medical Billing and Coding Specialist (CMBCS)

Certified Medical Billing and Coding Specialist (CMBCS) is a professional certification that recognizes individuals who have the knowledge, skills, and experience necessary to accurately code medical services for insurance reimbursement. The CMBCS certification is offered by the American Academy of Professional Coders (AAPC).

It typically takes between 6-12 months to complete the requirements for the CMBCS certification. To become certified, candidates must first pass an exam administered by AAPC. This exam covers topics such as medical terminology, anatomy and physiology, coding systems, reimbursement methodologies, and healthcare compliance. Candidates must also have at least two years of professional coding experience or complete an approved coding program prior to taking the exam.

The cost of obtaining the CMBCS certification varies depending on whether you are a member of AAPC or not. If you are a member of AAPC, then it will cost $199 for the exam plus any applicable taxes. Non-members will need to pay $399 plus taxes for the exam. In addition to these fees, there may be additional costs associated with studying materials or courses related to preparing for the exam.

4. Certified Patient Access Professional (CPAP)

Certified Patient Access Professional (CPAP) is a certification program offered by the National Association of Healthcare Access Management (NAHAM). It is designed to recognize individuals who have demonstrated a high level of knowledge and expertise in patient access services. The CPAP certification is awarded to those who successfully complete the NAHAM CPAP Exam, which covers topics such as patient registration, insurance verification, financial counseling, customer service, and medical records management.

The CPAP Exam consists of 150 multiple-choice questions and takes approximately three hours to complete. To be eligible for the exam, applicants must have at least two years of full-time experience in a healthcare setting or one year of full-time experience in a healthcare setting plus completion of an accredited healthcare access course.

To get certified as a CPAP professional, applicants must first register for the exam with NAHAM. The fee for registering for the exam is $400 and includes study materials and practice tests. Once registered, applicants must pass the exam within 12 months or their registration will expire and they will need to re-register for the exam.

Once an individual has passed the CPAP Exam, they will receive their official certification from NAHAM. This certification is valid for two years and can be renewed every two years by completing continuing education credits as required by NAHAM.

5. Certified Medical Office Manager (CMOM)

Certified Medical Office Manager (CMOM) is a professional certification for medical office managers. It is designed to recognize and reward the knowledge and skills of those who manage medical offices. The certification is offered through the American Academy of Professional Coders (AAPC).

To become certified, applicants must have at least two years of experience working in a medical office setting, as well as pass an exam administered by the AAPC. The exam covers topics such as patient care coordination, practice management, coding, billing, and compliance with laws and regulations.

It typically takes between six months and one year to prepare for the CMOM exam. During this time, applicants should take courses or study materials that cover relevant topics in medical office management. Additionally, they should gain practical experience in a medical office setting to ensure they are familiar with all aspects of managing a healthcare facility.

The cost to take the CMOM exam varies depending on the type of membership you have with AAPC. For non-members, it costs $399; for members it costs $299; and for student members it costs $199. Once you pass the exam, you will receive your CMOM certification which is valid for three years before needing to be renewed.

6. Certified Professional Coder (CPC)

Certified Professional Coder (CPC) is a certification offered by the American Academy of Professional Coders (AAPC). It is designed to recognize individuals who have demonstrated proficiency in medical coding and billing. The CPC certification is considered the gold standard for medical coding professionals and is widely respected in the healthcare industry.

It typically takes about 6 months to prepare for the CPC exam, although this can vary depending on your experience level and study habits. To get certified, you must pass a comprehensive exam that covers all aspects of medical coding, including ICD-10, CPT, HCPCS Level II, and modifiers. The exam consists of 150 multiple-choice questions and must be completed within 5 hours.

The cost of obtaining a CPC certification varies depending on your membership status with AAPC. For non-members, the cost is $399; for members it’s $299. Additionally, there are other costs associated with taking the exam such as registration fees ($50) and study materials ($200-$300).

7. Certified Professional in Healthcare Quality (CPHQ)

The Certified Professional in Healthcare Quality (CPHQ) is a credential offered by the National Association for Healthcare Quality (NAHQ). It is a professional certification that recognizes individuals who have demonstrated expertise in healthcare quality management and performance improvement. This certification is intended to demonstrate an individual’s knowledge of the principles, processes, and practices of healthcare quality.

To obtain the CPHQ credential, applicants must pass an exam administered by NAHQ. The exam consists of 200 multiple-choice questions covering topics such as healthcare quality management, performance improvement, patient safety, data analysis and utilization, risk management, and leadership/organizational development. The exam takes approximately four hours to complete.

Applicants must also meet certain eligibility requirements in order to be eligible for the CPHQ exam. These include having at least three years of full-time experience in a healthcare setting within the last five years; or having completed an approved educational program related to healthcare quality; or having held a position requiring significant responsibility related to healthcare quality for at least one year within the last five years.

The cost of taking the CPHQ exam is $395 for NAHQ members and $495 for non-members. Additionally, there are fees associated with renewing your certification every three years which range from $50-$100 depending on membership status.

8. American Academy of Professional Coders Certification (AAPC)

The American Academy of Professional Coders (AAPC) is a professional organization that provides certification and education to medical coders. It is the largest coding organization in the world, with more than 200,000 members. The AAPC offers several certifications for medical coders, including Certified Professional Coder (CPC) and Certified Professional Coder-Payer (CPC-P).

To get the CPC or CPC-P certification through the AAPC, you must first pass an exam. The exam consists of 150 multiple choice questions and takes approximately 4 hours to complete. You must also have a minimum of two years of professional coding experience to be eligible for either certification.

Once you have passed the exam and met all eligibility requirements, you will receive your certification from the AAPC. The cost of taking the exam varies depending on whether you are an AAPC member or not; non-members pay $399 while members pay $299. Additionally, there is an annual fee of $50 to maintain your certification status with the AAPC.

9. National Association of Healthcare Access Management Certification (NAHAM)

The National Association of Healthcare Access Management (NAHAM) is a professional organization dedicated to promoting excellence in healthcare access management. NAHAM Certification is the gold standard for healthcare access professionals and is recognized nationally as a mark of excellence.

NAHAM Certification requires that applicants demonstrate knowledge, skills, and abilities related to the practice of healthcare access management. This certification is available for both entry-level and experienced healthcare access professionals.

In order to be eligible for NAHAM Certification, applicants must have either two years of experience in the field or have completed an approved training program. In addition, they must pass an exam administered by NAHAM. The exam consists of 150 multiple-choice questions covering topics such as patient registration, insurance verification, scheduling, customer service, and more.

It typically takes between six and nine months to complete the certification process from start to finish. To get started, applicants should visit the NAHAM website and review the requirements for certification. They should then register for the exam and begin preparing for it by studying course materials provided by NAHAM or other approved sources.

The cost of NAHAM Certification varies depending on whether you are a member or non-member of NAHAM. For members, the cost is $395; for non-members it is $495. Additionally, there may be additional costs associated with taking the exam at a testing center or purchasing study materials from third parties.

10. American Health Information Management Association Certification (AHIMA)

The American Health Information Management Association (AHIMA) is a professional organization that provides certification for health information management professionals. AHIMA certifications are designed to recognize individuals who have the knowledge and skills necessary to manage, protect, and use health information.

AHIMA offers several different certifications, including Certified Coding Specialist (CCS), Certified Coding Associate (CCA), Registered Health Information Technician (RHIT), and Registered Health Information Administrator (RHIA). Each of these credentials requires passing an exam and meeting specific educational requirements.

It typically takes between six months to a year to prepare for an AHIMA certification exam. The amount of time it takes depends on the individual's experience level and the type of certification they are pursuing.

To get an AHIMA certification, individuals must first meet the eligibility criteria for their chosen credential. This includes having the necessary educational qualifications and experience in health information management or coding. Individuals must then register for the exam through AHIMA's website, pay the associated fees, and schedule their test date.

The cost of AHIMA certifications varies depending on which credential you are seeking. Generally speaking, exams range from $200-$400 USD per attempt with additional fees for retakes if needed.

11. National Alliance of Medical Auditing Specialists Certification (NAMAS).

The National Alliance of Medical Auditing Specialists (NAMAS) is a professional organization that provides certification for medical auditors. It is the only nationally recognized certification program for medical auditors.

The NAMAS Certified Medical Auditor (CMA) credential is designed to recognize and validate the knowledge, skills, and abilities of medical auditors. The CMA credential requires passing an examination that covers topics such as coding, compliance, reimbursement, and other related areas. The exam consists of 150 multiple-choice questions and takes approximately three hours to complete.

To be eligible for the CMA credential, applicants must meet certain requirements including having at least two years of experience in medical auditing or a related field; holding a current certification from another professional organization; or completing an approved training program in medical auditing. Additionally, applicants must pass a criminal background check and adhere to the NAMAS Code of Ethics.

The cost of obtaining the CMA credential varies depending on the applicant’s qualifications and experience. Generally speaking, it costs between $500-$1,000 to apply for the exam and receive the certification once passed. Re-certification is required every three years with continuing education credits earned through approved activities such as attending conferences or taking online courses.

Overall, obtaining the NAMAS Certified Medical Auditor credential can help professionals demonstrate their expertise in this field and provide them with greater opportunities for career advancement.

Do You Really Need a Provider Relations Representative Certificate?

No, you do not need a Provider Relations Representative Certificate to work in the provider relations field. While having a certificate may give you an edge over other candidates, many employers will hire someone with experience and knowledge of the industry regardless of whether or not they have a certificate.

Having said that, obtaining a Provider Relations Representative Certificate can be beneficial for those looking to advance their career in this field. It demonstrates to employers that you are up-to-date on current regulations and trends in the provider relations industry. Additionally, having a certificate may make it easier for you to find new job opportunities as employers may view your credentials as proof of your professional commitment and dedication to the field.

Ultimately, whether or not you decide to pursue a Provider Relations Representative Certificate is up to you and depends on your individual career goals. If you feel like obtaining certification would help you reach those goals, then it might be worth considering.

Related: Provider Relations Representative Resume Examples

FAQs About Provider Relations Representative Certifications

Q1. What is a Provider Relations Representative Certification?

A1. A Provider Relations Representative Certification is a professional certification that demonstrates that an individual has the knowledge, skills, and abilities necessary to effectively manage provider relations in healthcare organizations.

Q2. What are the benefits of becoming certified as a Provider Relations Representative?

A2. Becoming certified as a Provider Relations Representative can help you stand out from other candidates when applying for jobs, demonstrate your commitment to professional development, and help you advance your career in the field of healthcare provider relations. Additionally, it can provide you with access to resources and networking opportunities within the industry.

Q3. How do I become certified as a Provider Relations Representative?

A3. To become certified as a Provider Relations Representative, you must complete an approved certification program that includes coursework and/or examination requirements related to provider relations topics such as compliance management, patient advocacy, contract negotiation, customer service, and more.

Q4. How long does it take to earn a Provider Relations Representative Certification?

A4. The amount of time required to earn a Provider Relations Representative Certification varies depending on the program chosen; however, most programs require between three months and one year of study or preparation time before taking the certification exam.

Q5. Is there an expiration date on my certification?

A5: Yes—most certifications have an expiration date of two years from the date they were earned or renewed. To remain certified after two years, you must retake the certification exam or participate in continuing education courses approved by your certifying organization or board.