What is Credentialing in Healthcare?

You hear a lot about credentialing in healthcare but what does it mean for you as a working healthcare professional?

Credentialing is essentially the process of verifying that a provider is qualified to provide medical services. This will affect you when getting hired for a new job as a permanent employee or at the beginning of each assignment as a traveler. Knowing the basic idea of credentialing in healthcare is easy, but digging in and understanding exactly what the requirements are takes a bit more time.

10 Categories for Credentialing in Healthcare

1. Identification

You have to be able to prove you are legally allowed to work in the United States. You will need to provide this proof through a combination of your driver’s license, social security card, passport and proof of residency.

2. Licenses

Licensing is the formal recognition by a regulatory agency or body that a person has passed all the qualifications to practice that profession in that state. If a license is required to practice a profession in a state, it is unlawful to engage in the work without one and the consequences of doing so are very serious.

  • Licenses are granted on a state-by-state basis (or in some cases, as with the NLC you are granted the ability to move from participating states to other participating states).
  • Licensure requirements include some combination of education, training and examination to demonstrate competency.
  • Involve continuing education, training, and, for some, periodic re-examination.

3. Certifications

Credentialing in healthcare may look a bit different depending on your profession. For many in therapy and allied health, a certification is similar to a license. It shows you have undergone the necessary education and training to perform the job. But unlike licenses, certifications are often regulated by a national certifying body.

In addition to the above certification requirements, you will also need to provide proof of any additional certifications you may have acquired in addition to your licensure such as:

  • BLS, ACLS, CCRN, CEN, RRT-ACCS, chemotherapy, etc.

While some of these certifications may not be required for a job position, they can make getting the job easier and make you a more competitive candidate.

4. Medical Records

Medical records are necessary, particularly when going into a healthcare position. The most commonly asked for records include:

  • TB skin test/quantiferon test
  • Physical
  • Vaccination records
  • Mask fit tests

For vaccination records, you need to have proof of vaccination, proof of contamination (having the disease), titers, or a declination form. Titers tend to be the gold standard for vaccination records, as they show the current amount of antibodies within your system and therefore, boosters can be provided on an as needed basis.

There are 6 main vaccination records you should have available for credentialing-MMR, TDAP, Hepatitis B, Varicella, Flu and Covid.

Your TB skin test, physical and mask fit test are often organized by your agency or employer.

5. Background Checks

In general, you will need to undergo fingerprinting and background checks as part of the onboarding process. Prior to being hired for a permanent position and before each travel assignment (i.e. not an NLC state). For travelers, these checks must be run in every place you have lived/traveled so it can be extensive and time-consuming.

There are a few different background checks that can be conducted on the national, state, and county levels. On the national level, there are:

  • FACIS (Fraud and abuse control information systems) check which highlights anyone with disciplinary actions against them
  • NSOF (National Sex Offender Registry)
  • OIG (Office of Inspector General) Exclusions List which includes all healthcare providers excluded from participating in Medicare, Medicaid and other federal healthcare programs
  • SAM (System for Award Management) Exclusions List which includes a database of parties excluded from federal procurement (i.e. contracts, financial aid, non-financial benefits)
  • SS Trace (Social security trace) which checks for any aliases or duplicates of your social security number.

There are also state background checks for criminal offenses that are recommended, but optional, as well as county checks that are completely optional.

6. Drug Screens

As with background checks, the frequency varies with agency and assignment. Travelers should plan to take a drug test within 2 weeks of starting a new assignment while perm employees will be required to have one on hire and at the facilities discretion thereafter.

7. Education

If they are hiring you, then they believe in your knowledge and skills. Be sure to have your proof of education ready as a transcript or diploma.

8. References

You should have two references readily available from your most recent supervisors, managers, or charge team leads.

9. Competency Testing

You will most likely be required to take some online assessments to show your competency level within your specialty. The most common sites for these tests include Healthstream and Prophecy but they may also be held within your employer’s learning management system. These are generally tests to see your familiarity with common medications for your specialty, EKG rhythm detection, and common assessment/critical thinking scenarios.

10. Skills Checklist

These are similar to competency testing but are more of a self check-off form where you capture the frequency and proficiency of certain skills you will be encountering within the job. These are completed on hire/during submission to job and generally annually.

Keep Credentials Accessible

Credentialing in healthcare doesn’t have to be complicated if you are equipped with the right info and the right way to organize your documents. Having these items readily available through a universal job profile from Kamana will enable you, the healthcare provider, to get a job easier and faster. New job postings can come and go quickly, so having everything you need ready at the click of the button instead of hunting it down in a file will aid you in being one step ahead of the competition!

About the Author

As a registered nurse with over 5 years of critical care experience and 1 year of travel nursing, Shannon Hardy has a great understanding of how much work is put onto the backs of every healthcare professional each day. She loves finding inefficiencies in how things are currently done and speaking with those who actually deal with it to find solutions. With this in mind, Shannon sought out her MSN in Clinical Informatics and joined Kamana after graduation. She sees Kamana as the answer for how to reduce some of that daily stress, especially when it comes to the important things (like licenses) that help you stay working!

In her spare time, you may find her hiking with her dog and husband, traveling somewhere new, spending time with friends, or trying her hand at recipes seen on cooking shows.