A medical credentialing specialist verifies that the training, certifications and licenses of providers—professionals such as doctors, PAs and pharmacists who deliver medical care or health services to patients—are current and meet regulatory standards. Credentialing specialists work in hospitals, group practices, telehealth companies and credentialing agencies. They also confirm that medical facilities and services comply with the latest standards set by government agencies like the U.S. Centers for Medicare & Medicaid Services and accreditation bodies like The Joint Commission.
How to Become a Medical Credentialing Specialist in 2026
What does a medical credentialing specialist do?
A medical credentialing specialist verifies that the training, certifications and licenses of providers—professionals such as doctors, PAs and pharmacists who deliver medical care or health services to patients—are current and meet regulatory standards. Credentialing specialists work in hospitals, group practices, telehealth companies and credentialing agencies. They also confirm that medical facilities and services comply with the latest standards set by government agencies like the U.S. Centers for Medicare & Medicaid Services and accreditation bodies like The Joint Commission.
Healthcare credentialing touches every part of a medical organization's operations. Without it, providers can't bill insurance companies, hospitals can't admit people and new hires can't start seeing patients. It's a behind-the-scenes role, but the stakes are center stage.
What are the day-to-day responsibilities of a medical credentialing specialist?
You’ll start your day by logging into the credentialing database to see if any new provider applications need your attention. These are the provider’s credentialing or privileging submissions—forms and required documents (licenses, certifications, training, work history, attestations) that the organization needs to verify before granting the clinician the ability to practice. You’ll also need to follow up on ongoing cases.
You’ll prioritize your tasks by deadline and urgency. First up, you’ll process paperwork for a healthcare professional’s initial credentialing. This means carefully reviewing their application to make sure all the necessary information is there, like their education, training and work experience.
Once that’s done, you’ll switch gears to recredentialing a group of healthcare professionals whose credentials are up for renewal. This involves verifying that their licenses are current, checking for any disciplinary actions or malpractice claims, and ensuring they’ve completed the required continuing education courses. When something’s missing, you’ll reach out directly to providers or their offices.
After lunch, you’ll jump into a virtual meeting with colleagues from other facilities. These cross-facility meetings help standardize requirements and workflows across sites, coordinate on providers who practice at multiple locations (so records stay consistent and work isn’t duplicated), and share solutions and best practices to improve compliance and turnaround times. These video conferences are collaborative forums where specialists share observations and recommend improvements so leadership can decide what changes to adopt.
Later in the day, you might receive a request to help assess the credentialing practices of a new telemedicine service your organization is considering partnering with. You’ll review their policies and procedures and summarize your findings in a report. This will help leadership make an informed decision about whether to move forward with the partnership.
What qualifications do you need?
Most healthcare employers want candidates with at least an associate's degree in healthcare or business administration. Alternatively, you could have a high school diploma combined with experience working in a medical office—ideally as a medical administrative assistant or in a credentialing capacity. For credentialing manager roles, a bachelor's degree is typically preferred.
Certification isn't always required, but it helps you stand out. NAMSS, the National Association of Medical Staff Services, offers two levels: the Certified Provider Credentialing Specialist (CPCS) and the more advanced Certified Professional Medical Services Management (CPMSM). Both demonstrate expertise in regulations, policies and industry standards. To qualify for the CPCS, you need at least 12 consecutive months of employment in medical staff services within the past 24 months, plus three years of relevant experience within the past five years.
What technical skills matter most?
Proficiency in Microsoft Word and Excel remains essential, along with experience managing database systems. But healthcare credentialing is changing fast. Cloud-based software solutions are replacing older systems, and familiarity with platforms like CAQH ProView is increasingly valuable.
Automation and AI tools are also reshaping the field. Organizations using AI-powered credentialing solutions report up to 80% reduction in manual data entry and 30-40% improvement in first-pass accuracy rates for applications. Professionals who understand how these tools work—and can adapt as new ones emerge—will have a significant advantage.
Are soft skills important?
Never more so! Credentialing specialists must be highly organized, with an eagle eye for detail. Even small mistakes can have serious consequences, such as insurance companies withholding payments or practitioners losing their admitting privileges at hospitals.
Strong communication skills are equally important. You'll spend significant time interacting with people—from entry-level technicians to department heads and executives. The ability to explain complex requirements clearly, manage your emotions and handle sensitive conversations with diplomacy will serve you well throughout your career.
You'll also need to thrive under pressure and juggle multiple deadlines. Healthcare moves fast, and credentialing delays can ripple through an entire organization. According to the 2026 Salary Guide From Robert Half, 83% of administrative and customer support leaders offer higher pay to candidates with specialized skills, which includes expertise in credentialing processes combined with strong communication abilities.
Finally, medical credentialing specialists must maintain the highest standards of confidentiality and integrity. You’ll handle sensitive information such as practitioners’ health records, malpractice and claims history and criminal background checks. Employers seek candidates who understand the importance of discretion and can be trusted to handle this data responsibly.
What can you expect to earn?
According to the Salary Guide, credentialing specialists earn between $43,750 and $57,000 annually, depending on experience and certifications. Those who move into credentialing manager positions can earn more. Related roles like medical coding manager ($65,750–$84,750) also offer strong earning potential for those looking to advance.
Salary varies by location, industry and employer size. For the most accurate figures in your area, explore the Robert Half Salary Calculator.
Ready to take the next step?
If you're drawn to healthcare but prefer working behind the scenes rather than in direct patient care, medical credentialing offers a rewarding path with room to grow. The field is evolving alongside healthcare technology, and professionals who stay current with new tools and methods will be well-positioned for career advancement.
