Certified Professional Credentialing Specialist: Career Outlook

Published Oct 07, 2009

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Certified professional credentialing specialists (CPCS) work in hospitals, group practices, health plans, ambulatory care and credentialing verification institutions. The National Association Medical Staff Services, Board of Medical Specialty Coding, Professional Association of Healthcare Coding Specialist and American Academy of Professional Coders grant the CPCS designation. This certification is required for work as a medical credentialing specialist, certified coder specialist and a certified medical coder.

Medical Credentialing Specialist Overview and Career Outlook

Medical credentialing specialists scrutinize new applications, review requests for temporary privileges and proctor new staff members. They may also manage current licensure, certification and insurance certificates for existing staff. Medical credentialing specialists must know current compliancy requirements of all accrediting and regulatory agencies. The U.S. Bureau of Labor and Statistics (BLS), www.bls.gov, indicates that demand for medical credentialing specialist positions will be higher than the average growth rate from 2006 to 2016.

Certified Coding Specialist

Certified coding specialists are often assigned to certain specialization areas, such as Medicare outpatient claims. These coding specialists may be responsible for investigating questionable Medicare billing codes and claims. In addition, they may also handle claim denials by acting as liaison between physicians and other medical support departments. They are charged with maintaining consistent regulatory guideline education to appropriate staff members too. The BLS states that certified coding specialist positions will also grow faster than the average growth rate between 2006 and 2016.

Certified Medical Coder Overview and Career Outlook

Certified medical coders complete quality assurance reviews of patients' medical charts. They are proficient at coding according to the International Classification of Diseases (ICD) and the Hazard Characteristic Codes (HCC). Certified medical coders read countless medical charts and verify proper diagnosis codes for billing purposes. They also review requisitions from laboratories and other outpatient services to ensure completeness of the billing claim. The BLS reports that certified medical coders will be in great demand as America's population continues to age.

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