Advantages Of Hiring a Certified Professional Credentialing Specialist (CPCS)

If you’re not currently worrying about credentialing-related issues, then you probably have a great credentialing specialist — and you should go say thank you. If you’re dealing with issues related to provider eligibility, claim denials, delays, and lost revenue, you might be asking what is a CPCS?

A Certified Professional Credentialing Specialist (CPCS) is probably the most well-known designation for the credentialing profession. It’s a staple for professionals who want to rise up in the field — and for many healthcare organizations who value efficient and accurate credentialing. Read on to learn more about what is CPCS, who’s eligible, and the numerous benefits of this certification.

What Is CPCS (Certified Professional Credentialing Specialist)?

A CPCS has at least three years of experience in the field and has demonstrated their professional competency in provider credentialing practices. They have proven their skills at verifying a provider is qualified to perform and bill for certain health services as permitted by their medical training and licensure through primary source verification. 

Specialists with the CPCS certification are required to maintain this level of knowledge through renewals every three years and complete at least 30 hours of continuing education within the recertification period.

Who Is Eligible to Take the CPCS Exam?

The National Association Medical Staff Services (NAMSS) offers the CPCS exam. Before applying to sit for the exam, applicants must obtain a specific amount of hands-on credentialing experience. Applications must meet the following eligibility criteria:

1. Have a total of three years of experience in the medical services field within the past five years.
2. Be employed in medical services for at least 12 consecutive months in the last two years.

NAMSS does not consider a provider enrollment specialist a potential applicant, as their role does not qualify as direct, hands-on credentialing experience. Additionally, although they are intertwined, the provider credentialing and enrollment processes greatly differ.

Though the CPCS exam does not outline specific requirements regarding educational background, people seeking to become a credentialing specialist with a health organization must meet certain qualifications. Applicant requirements vary per organization, but typically, employers prefer a bachelor’s degree in a relevant field, such as healthcare administration or business. Some healthcare organizations employ people with a two-year college degree in a related field who can showcase their expertise in compliance regulation, time management, and problem-solving.

CPCS Exam Specifics

The CPCS exam tests a person’s knowledge of the provider credentialing process, encompassing these three areas:

• Credentialing and privileging: Analyzing and processing providers’ initial and credentialing applications. Collecting and verifying provider information while upholding compliance, accreditation, and federal standards.

• Ongoing monitoring: Ability to regularly monitor and maintain providers’ compliance and regulatory standards by using primary and secondary sources and databases.

• Supporting departmental operations: Performing internal and external audits of operational documents to help uphold accreditation and regulatory requirements.

Benefits of a CPCS Certification — For Professionals and Their Organizations

Individuals with a CPCS certification showcase their expertise in the field and, thus, enhance their value for the organization. 

Benefits for Credentialing Specialists

• Career advancement opportunities: The CPCS certification shows an individual has the knowledge and expertise in provider credentialing. Earning this certification could lead to opportunities for advancement since it also displays a commitment to the field.
• Increases salary potential: NAMSS reports on its website that more than 27% of people with a current CPCS certification received a salary increase after earning their certification. Thus, many individuals seek certification to increase their earning potential.
• Promotes career versatility: CPCS-certified credentialing specialists have the opportunity to work with many organizations, ranging from large health organizations to third-party credentialing companies. Many larger organizations require a CPCS certification, allowing for more job versatility within the industry.

Benefits for Healthcare Organizations

• Improves accuracy: The CPCS exam sets rigorous competency standards, so those who pass prove their expertise in provider credentialing practices, so organizations should run into fewer credentialing-related issues.
• Reduces delays: A Certified Professional Credentialing Specialist has experience in the field and should be able to complete credentialing more quickly. Plus, they have a network of CPCS-certified credentialing specialists who they can ask for help.
• Brings efficiency: CPCS-certified credentialing specialists are more likely to have used technology to improve their processes and can help improve your organization’s adoption.

Why CPCS-Certified Professionals Rely on Credentialing Software

A CPCS-certified credentialing specialist will bring accuracy and order to your organization’s credentialing. They have demonstrated competency and have years of experience in the field. They have also likely realized that making a shift to digital credentialing is the best way to maintain the accuracy and order that is expected.

Credentialing software, such as MedTrainer, puts all provider information in one central location with documents filed electronically and expiration dates logged. Redundant tasks like exclusions monitoring and license verifications are automated to save time and increase efficiency. 

Find out why many CPCS-certified professionals choose MedTrainer to improve their credentialing process.