A physician credentialer conducts research for hospitals to make sure physicians’ credentials are up-to-date, helps medical entities apply and renew credentials, and review applications for accuracy. Physician credentialers are also expected to follow applications through the process to make sure they have been approved, and do what must be done to correct them if they aren't.
Another aspect of the job is keeping track of credential documentation; the credentialer should make sure the affiliated insurance companies and hospitals all have updated records of these documents, such as board certificates, malpractice records, and medical licenses. Another service that a credentialer provides is keeping track of expiration dates for credentials so they can be renewed on-time.
Communication skills are essential, as the credentialer must contact various parties regarding the status of the credentials. He/she must also make sure that physicians’ National Provider Identifier (NPI) numbers are up-to-date in the system.
Those in this position keep track of insurance plans which can be used by certain physicians and which practices the physicians belong to. This is tracked electronically, so the credentialer should possess advanced computer skills. Advanced typing skills are also required, along with proficiency in Microsoft Office. Many positions require a minimum of a high school diploma, and related experience may also be required. Most jobs are carried out in an office environment during traditional business hours.
Physician Credentialer Tasks
Correspond with medical staff to obtain information or inform them of credentialing status or changes.
Maintain records of applications and verification letters.
Release information to persons and agencies according to regulations.
Evaluate information on applications to verify completeness and accuracy.